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      Myocardial work across different etiologies of right ventricular dysfunction and healthy controls


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          Evaluating right ventricular (RV) function remains a challenge. Recently, novel echocardiographic assessment of RV myocardial work (RVMW) by non-invasive pressure-strain loops was proposed. This enables evaluation of right ventriculoarterial coupling and quantifies RV dyssynchrony and post-systolic shortening. We aimed to assess RVMW in patients with different etiologies of RV dysfunction and healthy controls. We investigated healthy controls (n=17), patients with severe functional tricuspid regurgitation (FTR; n=22), and patients with precapillary pulmonary hypertension (PCPH; n=20). Echocardiography and right heart catheterization were performed to assess 1) RV global constructive work (RVGCW; work needed for systolic myocardial shortening and isovolumic relaxation), 2) RV global wasted work (RVGWW; myocardial shortening following pulmonic valve closure), and 3) RV global work efficiency (RVGWE; describes the relation between RV constructive and wasted work). RVGCW correlated with invasive RV stroke work index (r=0.66, P<0.001) and increased in tandem with higher afterload, i.e., was low in healthy controls (454±73 mmHg%), moderate in patients with FTR (687±203 mmHg%), and highest among patients with PCPH (881±255 mmHg%). RVGWE was lower and RVGWW was higher in patients with FTR (86±8% and 91 mmHg% [53-140]) or PCPH (86±10% and 110 mmHg% [66-159]) as compared with healthy controls (96±3% and 10 mmHg%). RVMW by echocardiography provides a promising index of RV function to discriminate between patients with RV volume or pressure overload. The prognostic value of this measure needs to be settled in future studies.

          Graphical abstract

          Combining right heart catheterization and echocardiography, right ventricular (RV) pressure-strain loops were evaluated in healthy controls and in patients with severe functional tricuspid regurgitation (FTR) or precapillary pulmonary hypertension (PCPH). RV global constructive work (RVGCW) entails the work needed for systolic myocardial shortening and isovolumic relaxation; it increased in tandem with higher afterload. RV global wasted work (RVGWW) describes myocardial shortening following pulmonic valve closure and RV global work efficiency (RVGWE) is the ratio between RVGCW and RVGWW. RVGWW was higher and RVGWE was lower in both patient groups with RV hemodynamic overload.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s10554-023-03038-y.

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          Most cited references33

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          The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.
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                Author and article information

                Int J Cardiovasc Imaging
                Int J Cardiovasc Imaging
                The International Journal of Cardiovascular Imaging
                Springer Netherlands (Dordrecht )
                2 February 2024
                2 February 2024
                : 40
                : 3
                : 675-684
                [1 ]Department of Cardiology, Aarhus University Hospital, ( https://ror.org/040r8fr65) Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200 Denmark
                [2 ]Department of Clinical Medicine, Faculty of Health, Aarhus University, ( https://ror.org/01aj84f44) Aarhus, Denmark
                Author information
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                : 7 August 2023
                : 18 December 2023
                Funded by: Hede Nielsens Fonden
                Funded by: A.P. Møller and Hustru Chastine Mc-Kinney Møllers Fonden
                Funded by: FundRef http://dx.doi.org/10.13039/501100004954, Augustinus Fonden;
                Funded by: Sofus Carl Emil Friis and Hustru Olga Doris Friis’ Legat
                Funded by: FundRef http://dx.doi.org/10.13039/100007405, Hjerteforeningen;
                Funded by: Aarhus Universitet
                Original Paper
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                © Springer Nature B.V. 2024

                Cardiovascular Medicine
                myocardial work,right ventricle,pulmonary hypertension,tricuspid regurgitation


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