Right ventricular stroke work index by echocardiography in adult patients with pulmonary arterial hypertension

Autor: Johan E.P. Waktare, Anders Roijer, Anna Werther Evaldsson, Carl Meurling, Gustav Smith, Raluca Jumatate, Göran Rådegran, Annika Ingvarsson, Ellen Ostenfeld
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Cardiac Catheterization
medicine.medical_specialty
Ventricular Dysfunction
Right
Concordance
Population
030204 cardiovascular system & hematology
Inferior vena cava
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Internal medicine
medicine
Humans
Diseases of the circulatory (Cardiovascular) system
030212 general & internal medicine
Right heart catheterization
Prospective cohort study
education
Aged
Retrospective Studies
Angiology
Pulmonary Arterial Hypertension
education.field_of_study
business.industry
Research
Hemodynamics
Central venous pressure
Reproducibility of Results
Stroke volume
Middle Aged
Cardiac surgery
medicine.vein
Echocardiography
RC666-701
Ventricular Function
Right
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Right ventricular stroke work index
Zdroj: BMC Cardiovascular Disorders, Vol 21, Iss 1, Pp 1-10 (2021)
BMC Cardiovascular Disorders
ISSN: 1471-2261
Popis: BackgroundIn adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, resulting in a poor prognosis. In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) measured by right heart catheterization (RHC) represents a promising index for RV function. The aim of the present study was to comprehensively evaluate non-invasive measures to calculate RVSWI derived by echocardiography (RVSWIECHO) using RHC (RVSWIRHC) as a reference in adult PAH patients.MethodsRetrospectively, 54 consecutive treatment naïve patients with PAH (65 ± 13 years, 36 women) were analyzed. Echocardiography and RHC were performed within a median of 1 day [IQR 0–1 days]. RVSWIRHCwas calculated as: (mean pulmonary arterial pressure (mPAP)—mean right atrial pressure (mRAP)) x stroke volume index (SVI)RHC. Four methods for RVSWIECHOwere evaluated: RVSWIECHO-1 = Tricuspid regurgitant maximum pressure gradient (TRmaxPG) x SVIECHO, RVSWIECHO-2 = (TRmaxPG-mRAPECHO) x SVIECHO, RVSWIECHO-3 = TR mean gradient (TRmeanPG) x SVIECHOand RVSWIECHO-4 = (TRmeanPG–mRAPECHO) x SVIECHO. Estimation of mRAPECHOwas derived from inferior vena cava diameter.ResultsRVSWIRHCwas 1132 ± 352 mmHg*mL*m−2. In comparison with RVSWIRHCin absolute values, RVSWIECHO-1and RVSWIECHO-2was significantly higher (p ECHO-4was lower (p ECHO-3(p = 0.304). The strongest correlation, with RVSWIRHC, was demonstrated for RVSWIECHO-2(r = 0.78,p ECHO-1( r = 0.75,p ECHO-3and RVSWIECHO-4had moderate correlation (r = 0.66 and r = 0.69,p ECHO-3(ICC = 0.80, 95% CI 0.64–0.88,p ECHO-4(ICC = 0.73,95% CI 0.27–0.87,p ECHO-2(ICC = 0.55, 95% CI − 0.21–0.83,p ECHO-1(ICC = 0.45, 95% CI − 0.18–0.77,p ECHO-1was − 772 ± 385 (− 50 ± 20%) mmHg*mL*m−2, RVSWIECHO-2− 600 ± 339 (-41 ± 20%) mmHg*mL*m−2, RVSWIECHO-342 ± 286 (5 ± 25%) mmHg*mL*m−2and for RVSWIECHO-4214 ± 273 (23 ± 27%) mmHg*mL*m−2.ConclusionThe correlation with RVSWIRHCwas moderate to strong for all echocardiographic measures, whereas only RVSWIECHO-3displayed high concordance of absolute values. The results, however, suggest that RVSWIECHO-1or RVSWIECHO-3could be the preferable echocardiographic methods. Prospective studies are warranted to evaluate the clinical utility of such measures in relation to treatment response, risk stratification and prognosis in patients with PAH.
Databáze: OpenAIRE
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