Advanced hemodynamics for right ventricular failure: Evaluating the use of the myocardial performance score

The purpose of the study is to assess a novel hemodynamic parameter, right ventricular myocardial performance score (RV-MPS), as a marker for right ventricular function and prognosis for advanced heart failure patients.

A total of 800 pressure-volume loop in silico simulations were performed at various hemodynamic conditions. RV-MPS was calculated as (3 × pulmonary artery pulsatility index [PAPI] × right ventricular cardiac power output [RV-CPO]) / 2. For the validation cohort, a total of 223 patients with advanced heart failure who underwent invasive hemodynamic testing from January 2013 to December 2019 were included. Advanced hemodynamic parameters, including RV-CPO, PAPI, and RV-MPS were calculated.

In the simulation cohort, the median RV-CPO was (median 0.22, IQR: [0.08, 0.33] watts), RV coupling ratio was (median 1.3, IQR: [0.87, 1.85], and PAPI (median 2.2, IQR: [1.2, 3.5]), and the median RV-MPS was 0.74 (IQR: 0.19, 1.60). Simulations showed increases in RV E_ES and RV mechanical efficiency was associated with increase in RV-MPS for all conditions of stressed blood volume and arterial resistance. In the validation cohort, RV-MPS (OR: 0.64, 95% CI: [0.43, 0.97], p = 0.037), baseline creatinine (OR: 0.71, 95% CI: [0.51, 0.97], p = 0.32), and PCWP (OR: 1.05, 95% CI: [1.01, 1.10], p = 0.011) were independent predictors of composite outcome of death and need for heart replacement therapy at 1-year. Prior to left ventricular assist device implantation (n = 33), patients with RV-MPS <0.5 had significantly increased incidence of RV failure compared to patients with preserved RV-MPS ≥0.5 (66.7% vs. 16.7%, p = 0.003).

RV-MPS is a reliable estimator of RV function on in silico simulations. RV-MPS was an independent predictor of death or need for heart replacement therapy and may have a role in prognostication of advanced heart failure patients.