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Prognostic Value of Right Ventricular Global Wasted Work in Precapillary Pulmonary Hypertension : A 3D Echocardiographic Study

Venkateshvaran, Ashwin LU orcid ; Lindow, Thomas LU ; Jumatate, Raluca LU ; Kovacs, Attila ; Ingvarsson, Annika LU orcid ; Lindqvist, Per and Werther Evaldsson, Anna LU orcid (2025) In Echocardiography 42(11).
Abstract

AIM: Right ventricular (RV) function determines symptom burden and clinical outcomes in pulmonary hypertension (PH). Global wasted work (GWW) quantifies mechanical inefficiencies in RV performance associated with elevated afterload, but is inadequately characterized in precapillary PH. We assessed the association of GWW with echocardiographic indices of RV remodeling, RV-PA coupling and invasive hemodynamics, and evaluated its prognostic significance in precapillary PH.

METHODS AND RESULTS: Myocardial work indices were measured by 3D echocardiography in patients with well-defined precapillary PH who underwent right heart catheterization within 24 hours. Patients with poor image quality, significant valvular lesions and associated... (More)

AIM: Right ventricular (RV) function determines symptom burden and clinical outcomes in pulmonary hypertension (PH). Global wasted work (GWW) quantifies mechanical inefficiencies in RV performance associated with elevated afterload, but is inadequately characterized in precapillary PH. We assessed the association of GWW with echocardiographic indices of RV remodeling, RV-PA coupling and invasive hemodynamics, and evaluated its prognostic significance in precapillary PH.

METHODS AND RESULTS: Myocardial work indices were measured by 3D echocardiography in patients with well-defined precapillary PH who underwent right heart catheterization within 24 hours. Patients with poor image quality, significant valvular lesions and associated left heart disease were excluded. Among 61 patients, those with GWW ≥ 38 mmHg/% (n = 31) exhibited larger RV end-systolic volume (60 [42-71] vs. 42 [35-46] mL/m
2, p = 0.009), lower TAPSE (17 [16-20] vs. 20 [17-23] mm, p = 0.04), higher E
a (1.32[0.98-1.57] vs. 0.92 [0.64-1.29] mmHg/mL, p = 0.02) and higher pulmonary vascular resistance (11.1 [8.1-14.2] vs. 5.4 [3.4-8.7]WU, p = 0.002). GWW decreased as RV longitudinal strain and RV-PA coupling improved and increased with lower cardiac index and higher pulmonary vascular resistance. GWW outperformed conventional right ventricular indices in identifying patients at risk of death or transplantation (HR: 2.5 [1.1-5.7], p = 0.02).

CONCLUSIONS: Elevated GWW is associated with RV remodeling, worsening RV function and reduced survival in precapillary PH. Our results suggest that GWW may offer incremental prognostic value over conventional RV metrics, with potential implications for risk stratification and therapy management. Larger studies are warranted to validate these findings.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Hypertension, Pulmonary/physiopathology, Male, Female, Prognosis, Middle Aged, Echocardiography, Three-Dimensional/methods, Heart Ventricles/diagnostic imaging, Ventricular Function, Right/physiology, Ventricular Dysfunction, Right/physiopathology
in
Echocardiography
volume
42
issue
11
article number
e70344
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:41251226
  • scopus:105022227812
ISSN
0742-2822
DOI
10.1111/echo.70344
language
English
LU publication?
yes
additional info
© 2025 The Author(s). Echocardiography published by Wiley Periodicals LLC.
id
e1c3d813-bc9e-41e3-a9ca-0271763f0b83
date added to LUP
2025-11-20 09:17:04
date last changed
2025-12-06 04:01:40
@article{e1c3d813-bc9e-41e3-a9ca-0271763f0b83,
  abstract     = {{<p>AIM: Right ventricular (RV) function determines symptom burden and clinical outcomes in pulmonary hypertension (PH). Global wasted work (GWW) quantifies mechanical inefficiencies in RV performance associated with elevated afterload, but is inadequately characterized in precapillary PH. We assessed the association of GWW with echocardiographic indices of RV remodeling, RV-PA coupling and invasive hemodynamics, and evaluated its prognostic significance in precapillary PH.</p><p>METHODS AND RESULTS: Myocardial work indices were measured by 3D echocardiography in patients with well-defined precapillary PH who underwent right heart catheterization within 24 hours. Patients with poor image quality, significant valvular lesions and associated left heart disease were excluded. Among 61 patients, those with GWW ≥ 38 mmHg/% (n = 31) exhibited larger RV end-systolic volume (60 [42-71] vs. 42 [35-46] mL/m<br>
 2, p = 0.009), lower TAPSE (17 [16-20] vs. 20 [17-23] mm, p = 0.04), higher E<br>
 a (1.32[0.98-1.57] vs. 0.92 [0.64-1.29] mmHg/mL, p = 0.02) and higher pulmonary vascular resistance (11.1 [8.1-14.2] vs. 5.4 [3.4-8.7]WU, p = 0.002). GWW decreased as RV longitudinal strain and RV-PA coupling improved and increased with lower cardiac index and higher pulmonary vascular resistance. GWW outperformed conventional right ventricular indices in identifying patients at risk of death or transplantation (HR: 2.5 [1.1-5.7], p = 0.02).<br>
 </p><p>CONCLUSIONS: Elevated GWW is associated with RV remodeling, worsening RV function and reduced survival in precapillary PH. Our results suggest that GWW may offer incremental prognostic value over conventional RV metrics, with potential implications for risk stratification and therapy management. Larger studies are warranted to validate these findings.</p>}},
  author       = {{Venkateshvaran, Ashwin and Lindow, Thomas and Jumatate, Raluca and Kovacs, Attila and Ingvarsson, Annika and Lindqvist, Per and Werther Evaldsson, Anna}},
  issn         = {{0742-2822}},
  keywords     = {{Humans; Hypertension, Pulmonary/physiopathology; Male; Female; Prognosis; Middle Aged; Echocardiography, Three-Dimensional/methods; Heart Ventricles/diagnostic imaging; Ventricular Function, Right/physiology; Ventricular Dysfunction, Right/physiopathology}},
  language     = {{eng}},
  number       = {{11}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Echocardiography}},
  title        = {{Prognostic Value of Right Ventricular Global Wasted Work in Precapillary Pulmonary Hypertension : A 3D Echocardiographic Study}},
  url          = {{http://dx.doi.org/10.1111/echo.70344}},
  doi          = {{10.1111/echo.70344}},
  volume       = {{42}},
  year         = {{2025}},
}