The role of echocardiographic right-ventricular global wasted work in predicting hemodynamics and the risk profile in pulmonary arterial hypertension

Abstract Background/Introduction Novel echocardiographic indices of right ventricular myocardial work (RVMW), derived from non-invasive pressure-strain loops, are gaining ground for the evaluation of pulmonary arterial hypertension (PAH). However, their role in predicting hemodynamics and risk profile remains unclear. Purpose This study aimed to assess whether RVMW indices can identify patients at high risk for mortality and those with a worse hemodynamic profile as determined by right heart catheterization (RHC). Methods Patients with PAH, confirmed by RHC, with available echocardiographic images for RVMW estimation were analysed. Patients’ risk profile was determined according to guidelines. RV global work index (RVGWI), global constructive work (RVGCW), global wasted work (RVGWW), and global work efficiency (RVGWE) were measured and correlations with four RHC parameters (mean pulmonary artery pressure [mPAP], pulmonary vascular resistance [PVR], stroke volume index [SVI], pulmonary arterial compliance [PAC]) were explored. Spline curve analyses were utilized to identify RVMW indices’ cut-off values, associated with ‘high risk’ patients and a worse hemodynamic profile. Results RVMW analysis was completed in 58 PAH patients (58±14 years old, 72% female). RVGWW was significantly increased (p