Right ventricular stroke work index by echocardiography in adult patients with pulmonary arterial hypertension

Jumatate, Raluca; Ingvarsson, Annika; Smith, Gustav Jan; Roijer, Anders; Ostenfeld, Ellen; Waktare, Johan; Rådegran, Göran; Meurling, Carl; Werther Evaldsson, Anna

Right ventricular stroke work index by echocardiography in adult patients with pulmonary arterial hypertension

Mark

Jumatate, Raluca ^LU ; Ingvarsson, Annika ^LU

; Smith, Gustav Jan ^LU ; Roijer, Anders ^LU ; Ostenfeld, Ellen ^LU

; Waktare, Johan ; Rådegran, Göran ^LU ; Meurling, Carl ^LU and Werther Evaldsson, Anna ^LU (2021) In BMC Cardiovascular Disorders 21(1).

Abstract

BACKGROUND: In adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, resulting in a poor prognosis. In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) measured by right heart catheterization (RHC) represents a promising index for RV function. The aim of the present study was to comprehensively evaluate non-invasive measures to calculate RVSWI derived by echocardiography (RVSWIECHO) using RHC (RVSWIRHC) as a reference in adult PAH patients.

METHODS: Retrospectively, 54 consecutive treatment naïve patients with PAH (65 ± 13 years, 36 women) were analyzed. Echocardiography and RHC were performed within a median of 1 day [IQR... (More)

BACKGROUND: In adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, resulting in a poor prognosis. In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) measured by right heart catheterization (RHC) represents a promising index for RV function. The aim of the present study was to comprehensively evaluate non-invasive measures to calculate RVSWI derived by echocardiography (RVSWIECHO) using RHC (RVSWIRHC) as a reference in adult PAH patients.

METHODS: Retrospectively, 54 consecutive treatment naïve patients with PAH (65 ± 13 years, 36 women) were analyzed. Echocardiography and RHC were performed within a median of 1 day [IQR 0-1 days]. RVSWIRHC was calculated as: (mean pulmonary arterial pressure (mPAP)-mean right atrial pressure (mRAP)) x stroke volume index (SVI)RHC. Four methods for RVSWIECHO were evaluated: RVSWIECHO-1 = Tricuspid regurgitant maximum pressure gradient (TRmaxPG) x SVIECHO, RVSWIECHO-2 = (TRmaxPG-mRAPECHO) x SVIECHO, RVSWIECHO-3 = TR mean gradient (TRmeanPG) x SVIECHO and RVSWIECHO-4 = (TRmeanPG-mRAPECHO) x SVIECHO. Estimation of mRAPECHO was derived from inferior vena cava diameter.

RESULTS: RVSWIRHC was 1132 ± 352 mmHg*mL*m-2. In comparison with RVSWIRHC in absolute values, RVSWIECHO-1 and RVSWIECHO-2 was significantly higher (p < 0.001), whereas RVSWIECHO-4 was lower (p < 0.001). No difference was shown for RVSWIECHO-3 (p = 0.304). The strongest correlation, with RVSWIRHC, was demonstrated for RVSWIECHO-2 (r = 0.78, p < 0.001) and RVSWIECHO-1 ( r = 0.75, p < 0.001). RVSWIECHO-3 and RVSWIECHO-4 had moderate correlation (r = 0.66 and r = 0.69, p < 0.001 for all). A good agreement (ICC) was demonstrated for RVSWIECHO-3 (ICC = 0.80, 95% CI 0.64-0.88, p < 0.001), a moderate for RVSWIECHO-4 (ICC = 0.73, 95% CI 0.27-0.87, p < 0.001) and RVSWIECHO-2 (ICC = 0.55, 95% CI - 0.21-0.83, p < 0.001). A poor ICC was demonstrated for RVSWIECHO-1 (ICC = 0.45, 95% CI - 0.18-0.77, p < 0.001). Agreement of absolute values for RVSWIECHO-1 was - 772 ± 385 (- 50 ± 20%) mmHg*mL*m-2, RVSWIECHO-2 - 600 ± 339 (-41 ± 20%) mmHg*mL*m-2, RVSWIECHO-3 42 ± 286 (5 ± 25%) mmHg*mL*m-2 and for RVSWIECHO-4 214 ± 273 (23 ± 27%) mmHg*mL*m-2.

CONCLUSION: The correlation with RVSWIRHC was moderate to strong for all echocardiographic measures, whereas only RVSWIECHO-3 displayed high concordance of absolute values. The results, however, suggest that RVSWIECHO-1 or RVSWIECHO-3 could be the preferable echocardiographic methods. Prospective studies are warranted to evaluate the clinical utility of such measures in relation to treatment response, risk stratification and prognosis in patients with PAH.

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Please use this url to cite or link to this publication: https://lup.lub.lu.se/record/8678dc41-9b28-48d7-bd50-496eb20418e7

author

Jumatate, Raluca ^LU ; Ingvarsson, Annika ^LU

; Smith, Gustav Jan ^LU ; Roijer, Anders ^LU ; Ostenfeld, Ellen ^LU

; Waktare, Johan ; Rådegran, Göran ^LU ; Meurling, Carl ^LU and Werther Evaldsson, Anna ^LU

organization

publishing date

2021-12

type

Contribution to journal

publication status

published

subject

Cardiac and Cardiovascular Systems

keywords

Aged, Cardiac Catheterization, Echocardiography, Female, Hemodynamics, Humans, Male, Middle Aged, Predictive Value of Tests, Pulmonary Arterial Hypertension/complications, Reproducibility of Results, Retrospective Studies, Ventricular Dysfunction, Right/diagnostic imaging, Ventricular Function, Right

in

BMC Cardiovascular Disorders

volume

21

issue

1

article number

219

publisher

BioMed Central (BMC)

external identifiers

pmid:33931021
scopus:85104931608

ISSN

1471-2261

DOI

10.1186/s12872-021-02037-y

language

English

LU publication?

yes

id

8678dc41-9b28-48d7-bd50-496eb20418e7

date added to LUP

2021-05-10 15:10:33

date last changed

2024-06-15 10:59:21

@article{8678dc41-9b28-48d7-bd50-496eb20418e7,
  abstract     = {{<p>BACKGROUND: In adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, resulting in a poor prognosis. In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) measured by right heart catheterization (RHC) represents a promising index for RV function. The aim of the present study was to comprehensively evaluate non-invasive measures to calculate RVSWI derived by echocardiography (RVSWIECHO) using RHC (RVSWIRHC) as a reference in adult PAH patients.</p><p>METHODS: Retrospectively, 54 consecutive treatment naïve patients with PAH (65 ± 13 years, 36 women) were analyzed. Echocardiography and RHC were performed within a median of 1 day [IQR 0-1 days]. RVSWIRHC was calculated as: (mean pulmonary arterial pressure (mPAP)-mean right atrial pressure (mRAP)) x stroke volume index (SVI)RHC. Four methods for RVSWIECHO were evaluated: RVSWIECHO-1 = Tricuspid regurgitant maximum pressure gradient (TRmaxPG) x SVIECHO, RVSWIECHO-2 = (TRmaxPG-mRAPECHO) x SVIECHO, RVSWIECHO-3 = TR mean gradient (TRmeanPG) x SVIECHO and RVSWIECHO-4 = (TRmeanPG-mRAPECHO) x SVIECHO. Estimation of mRAPECHO was derived from inferior vena cava diameter.</p><p>RESULTS: RVSWIRHC was 1132 ± 352 mmHg*mL*m-2. In comparison with RVSWIRHC in absolute values, RVSWIECHO-1 and RVSWIECHO-2 was significantly higher (p &lt; 0.001), whereas RVSWIECHO-4 was lower (p &lt; 0.001). No difference was shown for RVSWIECHO-3 (p = 0.304). The strongest correlation, with RVSWIRHC, was demonstrated for RVSWIECHO-2 (r = 0.78, p &lt; 0.001) and RVSWIECHO-1 ( r = 0.75, p &lt; 0.001). RVSWIECHO-3 and RVSWIECHO-4 had moderate correlation (r = 0.66 and r = 0.69, p &lt; 0.001 for all). A good agreement (ICC) was demonstrated for RVSWIECHO-3 (ICC = 0.80, 95% CI 0.64-0.88, p &lt; 0.001), a moderate for RVSWIECHO-4 (ICC = 0.73, 95% CI 0.27-0.87, p &lt; 0.001) and RVSWIECHO-2 (ICC = 0.55, 95% CI - 0.21-0.83, p &lt; 0.001). A poor ICC was demonstrated for RVSWIECHO-1 (ICC = 0.45, 95% CI - 0.18-0.77, p &lt; 0.001). Agreement of absolute values for RVSWIECHO-1 was - 772 ± 385 (- 50 ± 20%) mmHg*mL*m-2, RVSWIECHO-2 - 600 ± 339 (-41 ± 20%) mmHg*mL*m-2, RVSWIECHO-3 42 ± 286 (5 ± 25%) mmHg*mL*m-2 and for RVSWIECHO-4 214 ± 273 (23 ± 27%) mmHg*mL*m-2.</p><p>CONCLUSION: The correlation with RVSWIRHC was moderate to strong for all echocardiographic measures, whereas only RVSWIECHO-3 displayed high concordance of absolute values. The results, however, suggest that RVSWIECHO-1 or RVSWIECHO-3 could be the preferable echocardiographic methods. Prospective studies are warranted to evaluate the clinical utility of such measures in relation to treatment response, risk stratification and prognosis in patients with PAH.</p>}},
  author       = {{Jumatate, Raluca and Ingvarsson, Annika and Smith, Gustav Jan and Roijer, Anders and Ostenfeld, Ellen and Waktare, Johan and Rådegran, Göran and Meurling, Carl and Werther Evaldsson, Anna}},
  issn         = {{1471-2261}},
  keywords     = {{Aged; Cardiac Catheterization; Echocardiography; Female; Hemodynamics; Humans; Male; Middle Aged; Predictive Value of Tests; Pulmonary Arterial Hypertension/complications; Reproducibility of Results; Retrospective Studies; Ventricular Dysfunction, Right/diagnostic imaging; Ventricular Function, Right}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Cardiovascular Disorders}},
  title        = {{Right ventricular stroke work index by echocardiography in adult patients with pulmonary arterial hypertension}},
  url          = {{http://dx.doi.org/10.1186/s12872-021-02037-y}},
  doi          = {{10.1186/s12872-021-02037-y}},
  volume       = {{21}},
  year         = {{2021}},
}

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Right ventricular stroke work index by echocardiography in adult patients with pulmonary arterial hypertension