Aim Right ventricular (RV) function determines symptom burden and clinical outcomes
in pulmonary hypertension (PH). Global wasted work (GWW) quantifies mechanical inefficiencies
in RV performance associated with elevated afterload, but is inadequately characterized
in precapillary PH. We assessed the association of GWW with echocardiographic indices
of RV remodeling, RV-PA coupling and invasive hemodynamics, and evaluated its prognostic
significance in precapillary PH.Methods and Results Myocardial work indices were measured
by 3D echocardiography in patients with well-defined precapillary PH who underwent
right heart catheterization within 24 hours. Patients with poor image quality, significant
valvular lesions and associated left heart disease were excluded. Among 61 patients,
those with GWW >= 38 mmHg/% (n = 31) exhibited larger RV end-systolic volume (60 [42-71]
vs. 42 [35-46] mL/m2, p = 0.009), lower TAPSE (17 [16-20] vs. 20 [17-23] mm, p = 0.04),
higher Ea (1.32[0.98-1.57] vs. 0.92 [0.64-1.29] mmHg/mL, p = 0.02) and higher pulmonary
vascular resistance (11.1 [8.1-14.2] vs. 5.4 [3.4-8.7]WU, p = 0.002). GWW decreased
as RV longitudinal strain and RV-PA coupling improved and increased with lower cardiac
index and higher pulmonary vascular resistance. GWW outperformed conventional right
ventricular indices in identifying patients at risk of death or transplantation (HR:
2.5 [1.1-5.7], p = 0.02).Conclusions Elevated GWW is associated with RV remodeling,
worsening RV function and reduced survival in precapillary PH. Our results suggest
that GWW may offer incremental prognostic value over conventional RV metrics, with
potential implications for risk stratification and therapy management. Larger studies
are warranted to validate these findings.
