Right Ventricular Work and Pulmonary Capillary Wedge Pressure in Heart Failure with Preserved Ejection Fraction

Abstract

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.