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Right ventricular stroke work index from echocardiography in patients with pulmonary arterial hypertension-the role in short-term follow-up assessment

Jumatate, Raluca LU ; Werther Evaldsson, Anna LU orcid ; Ingvarsson, Annika LU orcid ; Rådegran, Göran LU ; Cronstedt Meurling, Carl LU and Ostenfeld, Ellen LU orcid (2024) In European Heart Journal Imaging Methods & Practice 2(3).
Abstract
Aims
Right ventricular (RV) failure causes high mortality in patients with pulmonary arterial hypertension (PAH). RV stroke work index (RVSWi) poses as a potential predictor of outcome. We evaluated how RVSWi by echocardiography (ECHO) or right heart catheterization (RHC) is altered following PAH treatment and if RVSWi is an indicator of outcome in PAH.
Methods and results
Fifty-four patients with PAH performed ECHO and RHC (median, 0 days between examinations) at baseline and treatment follow-up. RVSWiRHC was computed as (mPAP-mRAP)×SViRHC, (mPAP, mean pulmonary arterial pressure; mRAP, mean right atrial pressure; SVi, stroke volume indexed to body surface area). ECHO-derived RVSWi was calculated as RVSWiECHO-Mean = TRmeanPG ×... (More)
Aims
Right ventricular (RV) failure causes high mortality in patients with pulmonary arterial hypertension (PAH). RV stroke work index (RVSWi) poses as a potential predictor of outcome. We evaluated how RVSWi by echocardiography (ECHO) or right heart catheterization (RHC) is altered following PAH treatment and if RVSWi is an indicator of outcome in PAH.
Methods and results
Fifty-four patients with PAH performed ECHO and RHC (median, 0 days between examinations) at baseline and treatment follow-up. RVSWiRHC was computed as (mPAP-mRAP)×SViRHC, (mPAP, mean pulmonary arterial pressure; mRAP, mean right atrial pressure; SVi, stroke volume indexed to body surface area). ECHO-derived RVSWi was calculated as RVSWiECHO-Mean = TRmeanPG × SViECHO and RVSWiECHO-Max = TRmaxPG × SViECHO (TRmeanPG and TRmaxPG: tricuspid regurgitant mean and maximum pressure gradient). Invasive sPAP, mPAP, and pulmonary vascular resistance decreased and SVi increased from baseline to follow-up (P < 0.01 for all). RVSWiRHC and RVSWiECHO (Mean and Max) did not differ from baseline to follow-up (P > 0.05). Forty patients died during 109 ± 24 months. In univariate Cox proportional hazard analysis, age > 65 years, 6-minute-walk test < 160 m, WHO class III-IV and indexed right atrial volume were associated with long-term mortality, but none of the RVSWi methods. In multivariate analysis with clinical parameters, both RVSWiECHO methods were independently associated with mortality.
Conclusion
The RVSWi methods did not differ from baseline to short-term follow-up and were not associated with long-term outcomes in univariate analysis. However, baseline RVSWiECHO was associated with mortality when adjusting for clinical parameters. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Heart Journal Imaging Methods & Practice
volume
2
issue
3
article number
qyae128
publisher
Oxford University Press
external identifiers
  • pmid:39737112
ISSN
2755-9637
DOI
10.1093/ehjimp/qyae128
language
English
LU publication?
yes
id
c96d5149-9e8f-419a-aa1e-c9b21cedb9dc
date added to LUP
2025-01-02 09:36:24
date last changed
2025-04-04 14:44:23
@article{c96d5149-9e8f-419a-aa1e-c9b21cedb9dc,
  abstract     = {{Aims<br/>Right ventricular (RV) failure causes high mortality in patients with pulmonary arterial hypertension (PAH). RV stroke work index (RVSWi) poses as a potential predictor of outcome. We evaluated how RVSWi by echocardiography (ECHO) or right heart catheterization (RHC) is altered following PAH treatment and if RVSWi is an indicator of outcome in PAH.<br/>Methods and results<br/>Fifty-four patients with PAH performed ECHO and RHC (median, 0 days between examinations) at baseline and treatment follow-up. RVSWiRHC was computed as (mPAP-mRAP)×SViRHC, (mPAP, mean pulmonary arterial pressure; mRAP, mean right atrial pressure; SVi, stroke volume indexed to body surface area). ECHO-derived RVSWi was calculated as RVSWiECHO-Mean = TRmeanPG × SViECHO and RVSWiECHO-Max = TRmaxPG × SViECHO (TRmeanPG and TRmaxPG: tricuspid regurgitant mean and maximum pressure gradient). Invasive sPAP, mPAP, and pulmonary vascular resistance decreased and SVi increased from baseline to follow-up (P &lt; 0.01 for all). RVSWiRHC and RVSWiECHO (Mean and Max) did not differ from baseline to follow-up (P &gt; 0.05). Forty patients died during 109 ± 24 months. In univariate Cox proportional hazard analysis, age &gt; 65 years, 6-minute-walk test &lt; 160 m, WHO class III-IV and indexed right atrial volume were associated with long-term mortality, but none of the RVSWi methods. In multivariate analysis with clinical parameters, both RVSWiECHO methods were independently associated with mortality.<br/>Conclusion<br/>The RVSWi methods did not differ from baseline to short-term follow-up and were not associated with long-term outcomes in univariate analysis. However, baseline RVSWiECHO was associated with mortality when adjusting for clinical parameters.}},
  author       = {{Jumatate, Raluca and Werther Evaldsson, Anna and Ingvarsson, Annika and Rådegran, Göran and Cronstedt Meurling, Carl and Ostenfeld, Ellen}},
  issn         = {{2755-9637}},
  language     = {{eng}},
  month        = {{12}},
  number       = {{3}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal Imaging Methods & Practice}},
  title        = {{Right ventricular stroke work index from echocardiography in patients with pulmonary arterial hypertension-the role in short-term follow-up assessment}},
  url          = {{http://dx.doi.org/10.1093/ehjimp/qyae128}},
  doi          = {{10.1093/ehjimp/qyae128}},
  volume       = {{2}},
  year         = {{2024}},
}