Asymmetric right ventricular myocardial work correlates with gold standard measurements of cardiac function in pulmonary hypertension

Figures

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  Figure 1. Right ventricular pressure‐strain loops of the lateral wall and the septal wall from three different patients with mean pulmonary artery (PA) pressure at baseline, varying from normal (a) to moderately (b) and severely (c) elevated. Strain (%) is illustrated on the x‐axis and pressure (mmHg) on the y‐axis. The small circle on the loop indicates tricuspid valve closure and arrows indicate loop direction.

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  Figure 2. Graphs illustrating strain of the septum (upper curve) and simultaneously acquired myocardial septal work (lower graph) in a patient with mild (a) and severe (b) pulmonary hypertension, both at baseline. The patient with higher mean pulmonary artery pressure has lower positive myocardial work, higher negative myocardial work and substantially higher wasted work ratio, calculated from tricuspid valve closure (TVC) to pulmonary valve closure (PVC).

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  Figure 3. (a) Relationship between lateral and septal wall myocardial work (MW) and mean pulmonary artery pressure under all conditions (at baseline and during pulmonary vasodilation therapy with oxygen and nitric oxide). (b) Relationship between lateral and septal wall wasted work (WWR) and mean pulmonary artery pressure under all conditions.

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  Figure 4. (a) Illustration of myocardial work calculations representing the true loop area (blue) and the area included when calculating work without adjusting for the diastolic component (blue + red). (b) Pressure‐strain loops at baseline and with inhaled nitric oxide (solid line) illustrating a parallel shift of the curve but no significant change in loop area.

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  Figure 5. Linear regression analysis of correlation between right ventricular myocardial work (MW) and right ventricular dP/dt maximum (to the right of the y‐axis) and dP/dt minimum (to the left of the y‐axis) under all conditions (at baseline and during pulmonary vasodilation therapy with oxygen and inhaled nitric oxide).