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Right ventricular myocardial work: proof-of-concept for non-invasive assessment of right ventricular function

Open access
Butcher, Steele C, Fortuni, Federico, Montero-Cabezas, Jose M, Abou, Rachid, El Mahdiui, Mohammed, van der Bijl, Pieter, van der Velde, Enno T, Ajmone Marsan, Nina, Bax, Jeroen J, Delgado, Victoria·2021·European Heart Journal - Cardiovascular Imaging
DOI 10.1093/ehjci/jeaa261
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Abstract

Aims: Right ventricular myocardial work (RVMW) is a novel method for non-invasive assessment of right ventricular (RV) function utilizing RV pressure–strain loops. This study aimed to explore the relationship between RVMW and invasive indices of right heart catheterization (RHC) in a cohort of patients with heart failure with reduced left ventricular ejection fraction (HFrEF), and to compare values of RVMW with those of a group of patients without cardiovascular disease. Methods and results: Non-invasive analysis of RVMW was performed in 22 HFrEF patients [median age 63 (59–67) years] who underwent echocardiography and invasive RHC within 48 h. Conventional RV functional measurements, RV global constructive work (RVGCW), RV global work index (RVGWI), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were analysed and compared with invasively measured stroke volume and stroke volume index. Non-invasive analysis of RVMW was also performed in 22 patients without cardiovascular disease to allow for comparison between groups. None of the conventional echocardiographic parameters of RV systolic function were significantly correlated with stroke volume or stroke volume index. In contrast, one of the novel indices derived non-invasively by pressure–strain loops, RVGCW, demonstrated a moderate correlation with invasively measured stroke volume and stroke volume index (r = 0.63, P = 0.002 and r = 0.59, P = 0.004, respectively). RVGWI, RVGCW, and RVGWE were significantly lower in patients with HFrEF compared to a healthy cohort, while values of RVGWW were significantly higher. Conclusion: RVGCW is a novel parameter that provides an integrative analysis of RV systolic function and correlates more closely with invasively measured stroke volume and stroke volume index than other standard echocardiographic parameters.

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  • LV myocardial work indices are corrected for LV afterload, which is estimated based on a reference curve derived from the non-invasive systolic blood pressure.

    “LV MW indices are corrected for LV afterload, which is estimated based on a reference curve derived from the non-invasive systolic blood pressure [27].”

    From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [27]

  • Left or right ventricular bundle branch block, a very common finding in repaired TOF, can impact the echocardiographic estimation of LV systolic function and should be accounted for.

    “Moreover, left or right ventricular bundle branch block, which is a very common finding in repaired TOF, can impact the echocardiographic estimation of LV systolic function and should be accounted for [27].”

    From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [27]

  • Non-invasive myocardial work indices have been proposed to overcome the influence of loading conditions on conventional and advanced echocardiographic indices of systolic function.

    “Non-invasive myocardial work (MW) indices have been proposed to overcome the influence of loading conditions on conventional and advanced echocardiographic indices of systolic function [27,29].”

    From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [27]

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Metadata

Authors
Butcher, S. C., Fortuni, F., Montero-Cabezas, J. M., Abou, R., El Mahdiui, M., van der Bijl, P., van der Velde, E. T., Ajmone Marsan, N., Bax, J. J., & Delgado, V.
Affiliations
  • Royal Perth Hospital (AU)
  • University of Pavia (IT)
  • Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
  • Leiden University Medical Center (NL)
Corresponding author
Delgado, Victoria
ORCID
Venue
European Heart Journal - Cardiovascular Imaging
Publisher
Oxford University Press (OUP)
Published
2020-11-13
Volume
22
Issue
2
Pages
142-152
ISSN
  • 2047-2404 (ISSN-L)
  • 2047-2412
DOI
10.1093/ehjci/jeaa261
OpenAlex
W3102872209
Cited by
98
References
1
Citations by year
2026: 12 · 2025: 23 · 2024: 23 · 2023: 21 · 2022: 14 · 2021: 4 · 2020: 1
FWCI
6.19
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • European Heart Journal - Cardiovascular Imaging (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Leiden Repository (Leiden University) (submittedVersion, cc-by)
Funders
Abbott Vascular
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords
right ventricular function, pressure-strain loops, right heart catheterization, heart failure with reduced ejection fraction, stroke volume, non-invasive assessment, echocardiography
MeSH terms
Echocardiography, Heart Failure, Humans, Middle Aged, Stroke Volume, Ventricular Function, Left, Ventricular Function, Right, Ventricular Dysfunction, Right

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