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Biventricular performance in adults with a systemic right ventricle: new insights from myocardial work analysis

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Abstract

To evaluate biventricular mechanics by means of echo-derived myocardial work (MW) analysis in patients with a systemic right ventricle (sRV). Comprehensive echo data were collected in all patients with a sRV who underwent transthoracic echocardiography at our tertiary centre between 2020 and 2021 including sRV function indices, global longitudinal strain (GLS) of right and left ventricle (RV/LV), biventricular MW, and atrial strain in those with congenitally corrected transposition of the great arteries (ccTGA). Fifty-six patients (37 [30.97–45.87]years, 59% male) and 49 healthy individuals matched per age and sex were included for comparison. Global work index (GWI:1106 [869.80–1293.10] Vs 314.2 [281.5–358.2]mmHg%, p < 0.0001) and global constructive work(GCW: 1542.50 [1338.9–1718.50] Vs 416.4 [365.70–464]mmHg%, p < 0.0001) were both increased for sRV compared to normal RV, reflecting exposition to a systemic afterload, with a contemporary raise in wasted work (GWW:197 [138.50-322.20] Vs 26.09 [17.80–43.48]mmHg%, p < 0.0001) and impaired efficiency (GWE:89 [83–93.54] Vs 93.67 [91.67–96] %, p < 0.0001). Conversely, sRV showed reduced MW indices in comparison to normal LV(p < 0.0001 for all). Non-systemic LV demonstrated normal GLS values (19.51 ± 3.9%), but reduced GWI (479 [368–665] Vs 2172 [1978–2386]mmHg%, p < 0.0001) and GCW (708 [490–815]mmHg% Vs 86.5 [59.25–118], p < 0.0001). Nevertherless, non-systemic LV showed also impaired efficiency (91 [88–94] Vs 95 [94–97]%, p < 0.0001). LVGLS values were related to RVGLS (R = 0.5, p = 0.00019), suggesting a consistent interventricular dependency. Atrial strain could be assessed in 16 out of 20 (80%) patients with ccTGA: both atria had reduced strain values compared to their normal counterparts. Moreover, pulmonary atrial strain during the reservoir phase was related to LVGWE (R = 0.58, p = 0.047) and inversely related to LVGLS (R = − 0.71, p = 0.0043). MW analysis is feasible in sRV and may provide additional clinical data. In our cohort MW revealed biventricular impairment, in particular for non-systemic LV, in spite of normal GLS values.

Graphical abstract

Main research findings. Asterisks indicate p-value < 0.0001

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Data availability

No datasets were generated or analysed during the current study.

Abbreviations

EF:

Ejection fraction

FAC:

Fractional area change

GCW:

Global constructive work

GLS:

Global longitudinal strain

GWE:

Global work efficiency

GWI:

Global work index

GWW:

Global wasted work

LV:

Left ventricle

MW:

Myocardial work

sRV:

 Systemic right ventricle

ccTGA:

Congenitally corrected transposition of the great arteries

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Funding

This study has not received any funding.

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Author notes

  1. Flavia Fusco and Giancarlo Scognamiglio have contributed equally to this work.

Authors and Affiliations

  1. Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy

    Flavia Fusco, Giancarlo Scognamiglio, Davide Sorice, Massimiliana Abbate, Ippolita Altobelli & Berardo Sarubbi

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  1. Flavia Fusco
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  2. Giancarlo Scognamiglio
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Contributions

FF and GS conceptualized and wrote the manuscript, DS and GS collected the data, FF and MA analyzed the data, IA prepared the figures, BS finalized the draft. All authors have reviewed the manuscript.

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Correspondence to Flavia Fusco.

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Fusco, F., Scognamiglio, G., Sorice, D. et al. Biventricular performance in adults with a systemic right ventricle: new insights from myocardial work analysis. Int J Cardiovasc Imaging (2024). https://doi.org/10.1007/s10554-024-03076-0

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