Integrating oxygen uptake efficiency slope and right ventricular stroke work index in the assessment of right ventricular function in advanced heart failure with reduced ejection fraction
D Kosevic, J Stefanovic Neskovic, J Miladinovic, B Milovanovic, U Radak, N Andjelkovic, S Borovic, M BojicAbstract
Background
In advanced heart failure with reduced ejection fraction (HFrEF), accurate assessment of right ventricular ( RVF) function is essential for risk stratification and decision-making regarding advanced therapies. Oxygen uptake efficiency slope (OUES), derived from cardiopulmonary exercise testing (CPET), reflects integrated cardiopulmonary performance, whereas right ventricular stroke work index (RVSWI) provides an invasive hemodynamic measure of RV contractile function. Conventional echocardiographic parameters, are widely used but may not fully capture RV functional reserve in advanced disease.
Objectives
To evaluate the complementary value of OUES, RVSWI, and echocardiographic parameters in the assessment of RVF in patients with advanced HFrEF.
Methods
Forty patients with advanced HFrEF underwent symptom-limited CPET, transthoracic echocardiography, and invasive hemodynamic assessment. OUES was calculated from CPET data, RVSWI was obtained during right heart catheterization, and RV systolic function was assessed by trans thoracic echocardiography using TAPSE and FAC. Age, sex, and body mass index (BMI) were recorded. Associations between CPET-derived indices, invasive hemodynamic parameters, and echocardiographic measures were analyzed using Spearman correlation. Multivariable linear regression with robust standard errors was performed to identify independent determinants of RVSWI.
Results
The study population included 33 men and 7 women (mean age 45 ± 10 years; mean BMI 25.0 ± 3.6 kg/m²). RVSWI demonstrated a non-normal distribution (Shapiro–Wilk p<0.001). OUES was not significantly correlated with RVSWI (Spearman’s ρ = −0.04, p = 0.796), TAPSE (ρ = 0.12, p = 0.476), or FAC (ρ = −0.06, p = 0.694). Similarly, RVSWI showed no significant correlations with TAPSE (ρ = −0.05, p = 0.753) or FAC (ρ = −0.12, p = 0.467). In multivariable regression analysis adjusted for sex, age, and BMI, OUES was not independently associated with RVSWI (β = 0.76, 95% CI −0.39 to 1.92; p = 0.196), whereas male sex was associated with higher RVSWI (β = 1.59, p = 0.035) and higher BMI with lower RVSWI (β = −0.16, p = 0.019).
Conclusions
In patients with advanced HFrEF, CPET-derived oxygen uptake efficiency, invasive RVSWI, and echocardiographic parameters indices of RVF provide distinct information. The absence of significant associations between OUES, RVSWI, and conventional echocardiographic parameters underscores the limitations of single-modality RV assessment. A multimodal approach integrating CPET, echocardiography, cardiac magnetic resonance and invasive hemodynamics may enhance preoperative evaluation of RV reserve and improve identification of patients at risk for post–left ventricular assist device right ventricular failure or those who may benefit from alternative advanced mechanical circulatory support strategies.For image description, please refer to the figure legend and surrounding text.