Right Ventricular Work and Pulmonary Capillary Wedge Pressure in Heart Failure with Preserved Ejection Fraction
Authors: Huang Kuan-Chih , Lin Ting-Tse , Wu Cho-kai , Lin Lung-Chun , Lin Lian-Yu 
Published: September 2024

Background

Symptoms of heart failure with preserved ejection fraction (HFpEF) are closely related to elevated pulmonary capillary wedge pressure (PCWP) during exercise. Understanding right ventricular (RV) myocardial work, using RV pressure–strain loops to assess RV function in HFpEF, is lacking. The study aims to evaluate the effectiveness of right ventricular myocardial work parameters in diagnosing HFpEF and their correlation with pulmonary capillary wedge pressure during exercise.

Methods

The study included patients who underwent invasive cardiopulmonary exercise tests, measuring pressures at rest and during exercise to identify HFpEF. Echocardiography assessed left and right ventricular parameters. RV myocardial work was calculated using strain-rate and pressure curves, matched with ECG data. RV global constructive work (RV GCW), RV global work index (RV GWI), RV global wasted work (RV GWW), and RV global work efficiency (RV GWE) were analyzed and compared with invasively measured PCWP at rest and peak exercise.

Results

Forty-one patients with adequate data were enrolled, with 21 diagnosed with HFpEF. No significant differences in various echocardiographic parameters were found between HFpEF and non-HFpEF groups, except higher post-exercise PCWP and mean pulmonary artery pressure in HFpEF patients. HFpEF patients had higher RV GWW and lower RV GWE. RV GWW and RV GWE had higher predictive ability for HFpEF diagnosis compared to other echocardiographic parameters. RV GCW (r = 0.504, P = 0.001) and RV GWW (r = 0.621, P < 0.001) correlated with post-exercise ΔPCWP and exercise PCWP, with RV GWW independently associated with both after adjustment for confounding factors.

Conclusions

RV GWW is a novel predictive parameter that provides a better explanation of RV performance regarding post-exercise ΔPCWP than other standard echocardiographic parameters in HFpEF.

WHAT IS NEW?

Right ventricular global wasted work (RV GWW) is identified as a novel predictive parameter in heart failure with preserved ejection fraction (HFpEF), providing a more accurate explanation of right ventricular (RV) performance regarding post-exercise changes in pulmonary capillary wedge pressure (ΔPCWP) compared to standard echocardiographic parameters.

study highlights the significant correlation of RV GWW with post-exercise ΔPCWP and exercise PCWP, demonstrating its independent association after adjusting for confounding factors.

myocardial work, assessed using RV pressure–strain loops from invasive cardiopulmonary exercise tests and echocardiography, offers valuable insights into the role of RV in exercise intolerance and dyspnea among HFpEF patients.

WHAT ARE THE CLINICAL IMPLICATIONS?

RV GWW serves as a superior predictive marker for diagnosing HFpEF, independently correlating with post-exercise ΔPCWP. This enhances the understanding of RV contribution to exercise intolerance and dyspnea in HFpEF, potentially aiding in more accurate diagnosis and tailored management strategies.

RV GWW analysis in clinical practice may improve the diagnostic precision and management of HFpEF, optimizing treatment strategies for patients with unexplained dyspnea and suspected HFpEF.