Echocardiographic pressure-strain loop-derived stroke work significantly correlated with invasive pressure-volume loop-derived right ventricular stroke work (rho = 0.546, P < 0.001).
Observational (n=42)
Does echocardiographic pressure-strain loop-derived stroke work correlate with invasive pressure-volume loop-derived stroke work in patients with and without pulmonary hypertension?
Effect estimate: rho 0.546
p-value: p=<0.001
AIMS: Commercially available integrated software for echocardiographic measurement of stroke work (SW) is increasingly used for the right ventricle, despite a lack of validation. We sought to assess the validity of this method echo-based myocardial work (MW) module vs. gold-standard invasive right ventricular (RV) pressure-volume (PV) loops. METHODS AND RESULTS: From the prospectively recruiting EXERTION study (NCT04663217), we included 42 patients 34 patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) and 8 patients with absence of cardiopulmonary disease with RV echocardiography and invasive PV catheterization. Echocardiographic SW was assessed as RV global work index (RVGWI) generated via the integrated pressure-strain MW software. Invasive SW was calculated as the area bounded by the PV loop. An additional parameter derived from the MW module, RV global wasted work (RVGWW), was correlated with PV loop measures. RVGWI significantly correlated with invasive PV loop-derived RV SW in the overall cohort rho = 0.546 (P < 0.001) and the PAH/CTEPH subgroup rho = 0.568 (P < 0.001). Overall, RVGWW correlated with invasive measures of arterial elastance (Ea), the ratio of end-systolic elastance (Ees)/Ea, and end-diastolic elastance (Eed) significantly. CONCLUSIONS: Integrated echo measurement of pressure-strain loop-derived SW correlates with PV loop-based assessment of RV SW. Wasted work correlates with invasive measures of load-independent RV function. Given the methodological and anatomical challenges of RV work assessment, evolution of this approach by incorporating more elaborated echo analysis data and an RV reference curve might improve its reliability to mirror invasively assessed RV SW.
Richter et al. (Thu,) conducted a observational in Pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) (n=42). Echocardiographic pressure-strain loop-derived stroke work vs. Invasive right ventricular pressure-volume (PV) loops was evaluated on Correlation between echocardiographic RV global work index (RVGWI) and invasive PV loop-derived RV stroke work (rho 0.546, p=<0.001). Echocardiographic pressure-strain loop-derived stroke work significantly correlated with invasive pressure-volume loop-derived right ventricular stroke work (rho = 0.546, P < 0.001).