Journal of echocardiography · 2025
Echocardiographic Estimation of right ventricular stroke work index based on pulmonary regurgitant velocity in heart failure with reduced ejection fraction.
СтатьяНазвание и аннотация: Перевод в очереди
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Tateishi Yuta, Murayama Michito, Kaga Sanae, Yamazaki Kie, Ando Fuka, Goto Mana, Yanagi Yusuke, Yokoyama Shinobu, Nishino Hisao, Kambayashi Makoto, Shimono Yui, Nakamura Kosuke, Tamaki Yoji, Ishizaka Suguru, Iwano Hiroyuki, Nagai Toshiyuki, Anzai Toshihisa
Аннотация
BACKGROUND: Right ventricular (RV) dysfunction is a key determinant of mortality in heart failure with reduced left ventricular ejection fraction (HFrEF). RV stroke work index (RVSWI) is an established invasive parameter of RV function; however, echocardiographic methods for estimating RVSWI have not yet been fully established. We hypothesized that the pulmonary regurgitant (PR) velocity waveform-derived early-diastolic pulmonary artery-RV pressure gradient (PRPG) would allow an accurate estimation of RVSWI because of its fidelity to the original formula. This study aimed to investigate whether non-invasive estimation of RVSWI is feasible in patients with HFrEF.
METHODS: In this retrospective study, 120 adult patients with HFrEF who underwent right heart catheterization within 24 h of echocardiography were included. RVSWI was calculated as (mean pulmonary artery pressure - mean right atrial pressure) × stroke volume index (SVI). Based on the continuous-wave Doppler velocity measurements of PR, echocardiographic estimation of RVSWI was calculated as PRPG × pulsed-wave Doppler-derived SVI (RVSWIPR).
RESULTS: The RVSWIPR was significantly correlated with RVSWI (ρ = 0.670, p < 0.001). Bland-Altman analysis showed no direct fixed bias. Sensitivity analysis performed in 21 patients with HFrEF and severe tricuspid regurgitation, which is a challenging subgroup for non-invasive RV function assessment, showed similar results. In the receiver operating characteristic curve analyses to detect the patients with RVSWI < 250 mmHg∙mL/m2, the area under the curve was 0.954, and a cut-off value of 371 mmHg∙mL/m2 showed 100% sensitivity and 82% specificity.
CONCLUSIONS: RVSWIPR, based on PR velocity waveform analysis, was useful for the non-invasive assessment of RVSWI in HFrEF.
METHODS: In this retrospective study, 120 adult patients with HFrEF who underwent right heart catheterization within 24 h of echocardiography were included. RVSWI was calculated as (mean pulmonary artery pressure - mean right atrial pressure) × stroke volume index (SVI). Based on the continuous-wave Doppler velocity measurements of PR, echocardiographic estimation of RVSWI was calculated as PRPG × pulsed-wave Doppler-derived SVI (RVSWIPR).
RESULTS: The RVSWIPR was significantly correlated with RVSWI (ρ = 0.670, p < 0.001). Bland-Altman analysis showed no direct fixed bias. Sensitivity analysis performed in 21 patients with HFrEF and severe tricuspid regurgitation, which is a challenging subgroup for non-invasive RV function assessment, showed similar results. In the receiver operating characteristic curve analyses to detect the patients with RVSWI < 250 mmHg∙mL/m2, the area under the curve was 0.954, and a cut-off value of 371 mmHg∙mL/m2 showed 100% sensitivity and 82% specificity.
CONCLUSIONS: RVSWIPR, based on PR velocity waveform analysis, was useful for the non-invasive assessment of RVSWI in HFrEF.