Right Ventricular Myocardial Work Predicts Pulmonary Capillary Wedge Pressure Rise During Exercise in Heart Failure

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BACKGROUND: Symptoms of heart failure with preserved ejection fraction (HFpEF) are closely related to exercise-induced elevation in pulmonary capillary wedge pressure (PCWP). However, the diagnostic role of right ventricular (RV) myocardial work in HFpEF remains unclear. OBJECTIVES: The purpose of this study was to evaluate the diagnostic utility of RV myocardial work in HFpEF and their correlation with PCWP during exercise. METHODS: Patients with unexplained dyspnea underwent invasive cardiopulmonary exercise tests to identify HFpEF. Echocardiography assessed left and right ventricular parameters. RV myocardial work was calculated using strain rate and pressure curves, matched with electrocardiography data. RV global constructive work, RV global work index, RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were analyzed. 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 postexercise PCWP and mean pulmonary artery pressure in HFpEF patients. HFpEF patients had higher RVGWW and lower RVGWE. RVGWW and RVGWE demonstrated superior diagnostic performance for HFpEF compared to other echocardiographic parameters, with areas under the receiver operating characteristic curve of 0.85 (95% CI: 0.73-0.97) and 0.83 (95% CI: 0.70-0.96), respectively. RV global constructive work (r = 0.504; P = 0.001) and RVGWW (r = 0.621; P < 0.001) correlated with postexercise ΔPCWP and exercise PCWP, with RVGWW independently associated with both after adjustment for confounding factors. CONCLUSIONS: RVGWW is a novel predictive parameter that provides a better explanation of RV performance regarding postexercise ΔPCWP than other standard echocardiographic parameters in HFpEF.

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