Right ventricular myocardial work: proof-of-concept for non-invasive assessment of right ventricular function

Area of Science:

• Cardiology
• Echocardiography
• Cardiovascular Physiology

Background:

• Right ventricular myocardial work (RVMW) is an emerging non-invasive technique for evaluating right ventricular (RV) function using pressure-strain loops.
• Assessing RV function is crucial, especially in heart failure with reduced left ventricular ejection fraction (HFrEF), where RV dysfunction impacts prognosis.

Purpose of the Study:

• To investigate the correlation between non-invasively derived RVMW indices and invasive right heart catheterization (RHC) parameters in HFrEF patients.
• To compare RVMW values between HFrEF patients and a control group without cardiovascular disease.

Main Methods:

• Non-invasive RVMW analysis, including RV global constructive work (RVGCW), RV global work index (RVGWI), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE), was performed in 22 HFrEF patients and 22 controls.
• Echocardiography and RHC were conducted within 48 hours. Conventional RV systolic function parameters were compared with invasively measured stroke volume and stroke volume index.

Main Results:

• Conventional echocardiographic RV systolic function parameters did not significantly correlate with stroke volume or stroke volume index.
• RVGCW demonstrated a moderate correlation with invasively measured stroke volume (r=0.63) and stroke volume index (r=0.59).
• RVGWI, RVGCW, and RVGWE were significantly lower in HFrEF patients compared to controls, while RVGWW was significantly higher.

Conclusions:

• RVGCW is a novel parameter providing integrative analysis of RV systolic function.
• RVGCW shows closer correlation with invasively measured stroke volume and stroke volume index than standard echocardiographic parameters.
• RVMW indices differ significantly between HFrEF patients and healthy individuals, highlighting its potential in assessing RV dysfunction.