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Myocardial work of the systemic right ventricle and its association with outcomes

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Abstract

We aimed to evaluate clinical and prognostic significance of myocardial work parameters of the systemic right ventricle (SRV). Thirty-eight patients with the SRV underwent echocardiographic assessment of the SRV systolic function including 3D-echocardiography derived ejection fraction, 2D longitudinal strain and myocardial work analysis. The study endpoint was the combination of all-cause mortality and heart transplantation. Global constructive work (GCW) and global work index (GWI) demonstrated moderate correlation with the 3DE-derived SRV ejection fraction (EF) (Rho 0.64, p < 0.0001 and Rho 0.63, p < 0.0001, respectively). GCW showed the strongest correlation with the BNP level (Rho − 0.77, p < 0.0001), closely followed by GWI, 4-chamber longitudinal strain and 3DE EF (all Rho − 0.73, p < 0.0001). GCW and GWI were significantly lower in patients with moderate or severe tricuspid regurgitation compared with less than moderate regurgitation (1226 ± 439 vs 1509 ± 264 mmHg%, p = 0.02, and 984 ± 348 vs 1259 ± 278 mmHg%, p = 0.01, respectively). During a follow-up of 3.5 (2.8–3.9) years, seven patients (18%) died and one received transplantation (3%). They had significantly lower GCW and GWI compared with patients who did not reach the study endpoint (908 ± 255 vs 1433 ± %, p < 0.001 and 721 ± 210 vs 1173 ± 315 mmHg%, p < 0.001, respectively). In Cox regression analysis, GCW, GWI, 3DE SRV volumes and EF were the best-fit models based on the Akaike Information Criterion, outperforming longitudinal strain parameters. GWI and GCW, novel echocardiographic parameters of myocardial work, provided reliable quantification of the SRV systolic function. GWI, GCW and 3DE-derived SRV parameters were closely associated with all-cause mortality and heart transplantation in patients with the SRV.

Graphical abstract

Thirty-eight patients with the SRV underwent complete echocardiographic assessment of the SRV systolic function including 3D-echocardiography derived ejection fraction, 2D longitudinal strain and myocardial work analysis. GCW and GWI were associated with the study endpoint (combination of all-cause mortality and heart transplantation). In Cox regression analysis, GCW, GWI, and 3DE parameters were the best-fit models based on the Akaike Information Criterion, outperforming longitudinal strain parameters. 3DE three-dimensional echocardiography, EF ejection fraction, FAC fractional area change, GCW global constructive work, GWI global work index, LS longitudinal strain, LV left ventricle, SRV systemic right ventricle, TAPSE tricuspid annulus plane systolic excursion.

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No datasets were generated or analysed during the current study.

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Acknowledgements

The authors would like to express their most sincere gratitude to Dr Steele Butcher and Dr Victoria Delgado for their expert help with the technical aspects of the RV myocardial work analysis.

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Authors and Affiliations

  1. Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas’ NHS Foundation Trust, Sydney Street, Chelsea, London, SW3 6NP, UK

    Elena Surkova, Roxy Senior & Wei Li

  2. Heart and Vascular Center, Semmelweis University, 68, Varosmajor Str., Budapest, 1122, Hungary

    Bálint Károly Lakatos, Alexandra Fábián & Attila Kovács

  3. National Heart Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, Chelsea, London, SW3 6LY, UK

    Roxy Senior & Wei Li

Authors
  1. Elena Surkova
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  2. Bálint Károly Lakatos
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  3. Alexandra Fábián
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  4. Attila Kovács
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  5. Roxy Senior
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  6. Wei Li
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Contributions

E.S. and B.K.L. wrote the main manuscript text, E.S. prepared figures, B.K.L., A.F. and A.K prepared tables. R.S. and W.L. provided critical feedback for the overall project. All authors reviewed the manuscript.

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Correspondence to Elena Surkova.

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Conflict of interest

ES is an employee of AstraZeneca and reports speaker honoraria from GE Healthcare and 123sonography, outside of the submitted work. BKL, AF, and AK report personal fees from Argus Cognitive, Inc., outside the submitted work. Other authors report no relationships that could be construed as a conflict of interest.

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Surkova, E., Lakatos, B.K., Fábián, A. et al. Myocardial work of the systemic right ventricle and its association with outcomes. Int J Cardiovasc Imaging (2024). https://doi.org/10.1007/s10554-024-03081-3

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