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Background <p>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.</p> Methods <p>In this retrospective study, 120 adult patients with HFrEF who underwent right heart catheterization within 24&#xa0;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 (RVSWI<sub>PR</sub>).</p> Results <p>The RVSWI<sub>PR</sub> was significantly correlated with RVSWI (ρ = 0.670, <i>p</i> &lt; 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 &lt; 250 mmHg∙mL/m<sup>2</sup>, the area under the curve was 0.954, and a cut-off value of 371 mmHg∙mL/m<sup>2</sup> showed 100% sensitivity and 82% specificity.</p> Conclusions <p>RVSWI<sub>PR</sub>, based on PR velocity waveform analysis, was useful for the non-invasive assessment of RVSWI in HFrEF.</p>

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Echocardiographic Estimation of right ventricular stroke work index based on pulmonary regurgitant velocity in heart failure with reduced ejection fraction

  • 期刊论文

  • 发表日期：

    2025年12月4日

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  • Yuta Tateishi,
  • Michito Murayama,
  • Sanae Kaga,
  • Kie Yamazaki,
  • Fuka Ando,
  • Mana Goto,
  • Yusuke Yanagi,
  • Shinobu Yokoyama,
  • Hisao Nishino,
  • Makoto Kambayashi,
  • Yui Shimono,
  • Kosuke Nakamura,
  • Yoji Tamaki,
  • Suguru Ishizaka,
  • Hiroyuki Iwano,
  • Toshiyuki Nagai,
  • Toshihisa Anzai

摘要

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.