Prognostic Role of Simultaneous Assessment of Biventricular Function Using Left Ventricular Stroke Work Index and Right Ventricular Stroke Work Index

Abstract

<h3>Purpose</h3> We hypothesized that simultaneous assessment of biventricular function could predict clinical outcomes. <h3>Methods</h3> We reviewed 180 patients undergoing a milrinone drug study and right heart catheterization at our center from January 2013 to January 2019. Left ventricular stroke work index (LVSWI) was calculated as 0.0136 * ((cardiac index/heart rate) * 1000) * (mean arterial pressure - pulmonary capillary wedge pressure), and right ventricular stroke work index (RVSWI) was calculated as 0.0136 * ((cardiac index/heart rate) * 1000) * (mean pulmonary arterial pressure - right atrial pressure). Cutpoints were determined by ROC analysis. Patients were stratified as: (1) High LVSWI, High RVSWI; (2) High LVSWI, Low RVSWI; (3) Low LVSWI, High RVSWI; and (4) Low LVSWI, Low RVSWI. Univariate and multivariate logistic regression analyses were performed to determine association with escalation of therapy, defined as left ventricular assist device implantation, heart transplantation, or death. <h3>Results</h3> Cutpoints of 18.3 and 10 were determined for LVSWI and RVSWI, respectively. Low LVSWI, High RVSWI was associated with escalation of therapy or death at 30 days (OR 4, 95% CI 1.05 - 15.59, p = 0.041). All of the following statuses were associated with a negative outcome at one year: Low LVSWI, High RVSWI (OR 14, 95% CI 2.44 - 265.8, p = 0.015), Low LVSWI, Low RVSWI (OR 4.85, 95% CI 2.25 - 10.85, p <0.0001), and High LVSWI, High RVSWI (OR 2.45, 95% CI 1.06 - 5.87, p = 0.039). In multivariate analysis, Low LVSWI, High RVSWI and Low LVSWI, Low RVSWI were predictors of escalation of therapy or death at one year (OR 14.76, 95% CI 2.56-281.3, p = 0.013; OR 5.74, 95% CI 2.43 - 14.3, p <0.001, respectively). <h3>Conclusion</h3> Simultaneous assessment of biventricular function using LVSWI and RVSWI is associated with clinical outcomes and may be useful for risk stratification.