Noninvasive evaluation of indexes of right ventricular (RV) myocardial work (RVMW) derived from RV pressure-strain loops may provide novel insights into RV function in precapillary pulmonary hypertension. This study was designed to evaluate the association between the indexes of RVMW and invasive parameters of right heart catheterization and all-cause mortality. Noninvasive analysis of RVMW was completed in 51 patients (mean age 58.1 ± 12.7 years, 31% men) with group I or group IV pulmonary hypertension. RV global work index (RVGWI), RV global constructive work (RVGCW), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were compared with parameters derived invasively during right heart catheterization. Patients were followed-up for the occurrence of all-cause death. The median RVGWI, RVGCW, RVGWW, and RVGWE were 620 mm Hg%, 830 mm Hg%, 105 mm Hg% and 87%, respectively. Compared with conventional echocardiographic parameters of RV systolic function, RVGCW and RVGWI correlated more closely with invasively derived RV stroke work index (R = 0.63, p <0.001 and R = 0.60, p <0.001, respectively). Invasively derived pulmonary vascular resistance correlated with RVGWW (R = 0.63, p <0.001), RVGWE (R = 0.48, p <0.001), and RV global longitudinal strain (R = 0.58, p <0.001). RVGCW (hazard ratio 1.42 per 100 mm Hg% <900 mm Hg%, 95% confidence interval 1.12 to 1.81, p = 0.004) and RVGWI (hazard ratio 1.46 per 100 mm Hg% <650 mm Hg%, 95% confidence interval 1.09 to 1.94, p = 0.010) were significantly associated with all-cause mortality, whereas RV global longitudinal strain, RVGWE, and RVGWW were not. In conclusion, indexes of RVMW were more closely correlated with invasively derived RV stroke work index and peripheral vascular resistance than conventional echocardiographic parameters of RV systolic function. Decreased values of RVGCW and RVGWI were associated with all-cause mortality, whereas conventional echocardiographic parameters of RV function were not.

Background: Assessment of left ventricular (LV) function in patients with secondary mitral regurgitation (SMR) remains challenging but is an important parameter for risk stratification. The association of LV myocardial work components (work index [GWI], constructive [GCW] and wasted [GWW] work, and work efficiency) derived from pressure-strain loops obtained with speckle tracking echocardiography, and all-cause mortality in patients with SMR was investigated. Methods: LV myocardial GWI, GCW, GWW, and global work efficiency were measured with speckle tracking strain echocardiography in 373 patients (72% men, median age 68 years) with various grades of SMR. All-cause mortality was the primary end point. Results: Mild SMR was observed in 143 patients, 128 had moderate SMR, and 102 had severe SMR. Patients with severe SMR had the largest LV volumes and the worst LV ejection fraction and LV global longitudinal strain. In patients with severe SMR, LV GWI and GCW were more impaired (500 mm Hg% versus 680 mm Hg% P =0.024 and 678 mm Hg% versus 851 mm Hg% P =0.006, respectively), while GWW was lower (130 mm Hg% versus 260 mm Hg% P <0.001, respectively) and global work efficiency was significantly higher (82% versus 76%, P =0.001) compared with patients with mild SMR. After a median follow-up of 56 months, 161 patients died. LV GWI≤500 mm Hg%, LV GCW≤750 mm Hg%, and LV GWW<300 mm Hg% were independently associated with excess mortality. Conclusions: Patients with severe SMR had the worst LV GWI and LV GCW but better LV GWW and global work efficiency reflecting the unloading of the LV in the low-pressure left atrial chamber. These parameters were independently associated with worse long-term survival in patients with SMR.

Evidence on cardiac remodeling, left ventricular (LV) function recovery, medication use and outcomes in older ST-segment elevation myocardial infarction (STEMI) patients is limited. We examined these aspects at baseline and evolution one year post-infarct in patients aged ≥ 80 versus < 80.STEMI registry data were retrospectively analyzed. The older subgroup included patients aged ≥ 80 years at index hospitalization. Echocardiography was performed at baseline and one year after STEMI. LV remodeling was defined as > 20% relative increase in the LV end-diastolic volume. One-year cardiovascular outcomes and five-year all-cause mortality are reported.Study included 2178 patients; 132 (6.1%) were aged ≥ 80. Older patients had worse baseline LV ejection fraction (47.2 ± 9.6% versus 49.8 ± 8.2%; p < 0.001) and experienced more adverse LV remodeling (29% versus 19%; p = 0.024). Nevertheless, LV function improved similarly in both groups. Beta-blocker and renin-angiotensin-aldosterone system inhibitor use was lower (86.4% versus 94.2%; p < 0.001 and 90.2% versus 96.5%; p < 0.001, respectively) but diuretic prescription higher (18.2% versus 8.1%; p < 0.001) in older patients. One year post-infarct beta-blocker and renin-angiotensin-aldosterone system inhibitor use decreased and was similar in both groups, but older patients continued to receive more diuretics and suffered higher heart failure hospitalization rates (7.0% versus 2.6%; p = 0.006). Five-year mortality was 25.8% in older versus 4.3% in younger patients (log-rank χ2 133.2; p < 0.001).Older patients experienced more adverse LV remodeling, received less beta-blockers and renin-angiotensin-aldosterone system inhibitors but more diuretics at discharge and one year, compared to younger patients. Nevertheless, LV function recovered similarly in both groups.