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

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. RVSWi _RHC was computed as (mPAP-mRAP)×SVi _RHC , (mPAP, mean pulmonary arterial pressure; mRAP, mean right atrial pressure; SVi, stroke volume indexed to body surface area). ECHO-derived RVSWi was calculated as RVSWi _ECHO-Mean = TR _mean PG × SVi _ECHO and RVSWi _ECHO-Max = TR _max PG × SVi _ECHO (TR _mean PG and TR _max PG: 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). RVSWi _RHC and RVSWi _ECHO (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 RVSWi _ECHO 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 RVSWi _ECHO was associated with mortality when adjusting for clinical parameters.
Competing Interests: Conflict of interest: R.J: None, A.W.E.: None, A.I.: None. G.R. reports personal lecture fees from AOP Health/Orpha Care, Janssen, M.S.D., and Nordic Infucare outside the submitted work; and is or has been a primary investigator or co-investigator in clinical PAH trials for Acceleron, Actelion Pharmaceuticals Sweden AB, Acceleron, Bayer HealthCare, GlaxoSmithKline, Janssen, MSD, Pfizer and United Therapeutics and in clinical heart transplantation immunosuppression trials for Novartis. The companies had no role in the data collection, analysis, and interpretation and had no right to disapprove of the manuscript. C.C.M.: None, E.O.: None.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)