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BackgroundIn adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, resulting in a poor prognosis. In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) measured by right heart catheterization (RHC) represents a promising index for RV function. The aim of the present study was to comprehensively evaluate non-invasive measures to calculate RVSWI derived by echocardiography (RVSWIECHO) using RHC (RVSWIRHC) as a reference in adult PAH patients.MethodsRetrospectively, 54 consecutive treatment naïve patients with PAH (65 ± 13 years, 36 women) were analyzed. Echocardiography and RHC were performed within a median of 1 day [IQR 0–1 days]. RVSWIRHCwas calculated as: (mean pulmonary arterial pressure (mPAP)—mean right atrial pressure (mRAP)) x stroke volume index (SVI)RHC. Four methods for RVSWIECHOwere evaluated: RVSWIECHO-1 = Tricuspid regurgitant maximum pressure gradient (TRmaxPG) x SVIECHO, RVSWIECHO-2 = (TRmaxPG-mRAPECHO) x SVIECHO, RVSWIECHO-3 = TR mean gradient (TRmeanPG) x SVIECHOand RVSWIECHO-4 = (TRmeanPG–mRAPECHO) x SVIECHO. Estimation of mRAPECHOwas derived from inferior vena cava diameter.ResultsRVSWIRHCwas 1132 ± 352 mmHg*mL*m−2. In comparison with RVSWIRHCin absolute values, RVSWIECHO-1and RVSWIECHO-2was significantly higher (p ECHO-4was lower (p ECHO-3(p = 0.304). The strongest correlation, with RVSWIRHC, was demonstrated for RVSWIECHO-2(r = 0.78,p ECHO-1( r = 0.75,p ECHO-3and RVSWIECHO-4had moderate correlation (r = 0.66 and r = 0.69,p ECHO-3(ICC = 0.80, 95% CI 0.64–0.88,p ECHO-4(ICC = 0.73,95% CI 0.27–0.87,p ECHO-2(ICC = 0.55, 95% CI − 0.21–0.83,p ECHO-1(ICC = 0.45, 95% CI − 0.18–0.77,p ECHO-1was − 772 ± 385 (− 50 ± 20%) mmHg*mL*m−2, RVSWIECHO-2− 600 ± 339 (-41 ± 20%) mmHg*mL*m−2, RVSWIECHO-342 ± 286 (5 ± 25%) mmHg*mL*m−2and for RVSWIECHO-4214 ± 273 (23 ± 27%) mmHg*mL*m−2.ConclusionThe correlation with RVSWIRHCwas moderate to strong for all echocardiographic measures, whereas only RVSWIECHO-3displayed high concordance of absolute values. The results, however, suggest that RVSWIECHO-1or RVSWIECHO-3could be the preferable echocardiographic methods. Prospective studies are warranted to evaluate the clinical utility of such measures in relation to treatment response, risk stratification and prognosis in patients with PAH.

Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Swedish Society of Pulmonary Hypertension Background In adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, constituting a negative prognostic factor. In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) reflects right ventricular function and has been proposed to predict outcome in PAH. However, RVSWI assessed by echocardiography (ECHO) has not been thoroughly compared to measures with right heart catheterization (RHC) in adults. The aim of the present study was to therefore evaluate RVSWI derived by echocardiography (RVSWIECHO) vs. RHC (RVSWIRHC). Methods Fifty-four consecutive treatment naïve adult patients with PAH, were retrospectively analysed. All patients performed echocardiography and RHC with a median time of 1 day [IQR 0-1 days]. RVSWIRHC was calculated as: (mean pulmonary arterial pressure (mPAP) – mean right atrial pressure (mRAP)) x stroke volume index (SVI)RHC. Four methods for RVSWIECHO were evaluated: RVSWIECHO-1 = Tricuspid regurgitant maximum pressure gradient (TRmaxPG) x SVIECHO, RVSWIECHO-2=(TRmaxPG-mRAPECHO) x SVIECHO, RVSWIECHO-3 = TR mean gradient (TRmPG) x SVIECHO and RVSWIECHO-4=(TRmPG–mRAPECHO) x SVIECHO. Vena cava inferior diameter and its collapsibility were used for estimation of mRAPECHO.. Pearson’s correlation coefficients were used and data was expressed as mean ± standard deviation. Results Mean RVSWIRHC was 1132 ± 352 mmHg*mL*m-2. Mean RVSWIECHO-1-4 was: 1904 ± 568, 1732 ± 531, 1090 ± 366 and 918 ± 336 mmHg*mL*m-2, respectively. There was no significant difference between RVSWIRHC and RVSWIECHO-3 in mean values, although they exhibited the lowest correlation, but moderate (r = 0.66). The strongest correlation was demonstrated for RVSWIECHO-2 (r = 0.78, p Conclusion RVSWIECHO-3, using the mean tricuspid gradient and SVIECHO, showed no significant difference to RVSWIRHC, albeit a moderate correlation between the methods. RVSWIECHO-1, RVSWIECHO- 2 and RVSWIECHO-4 exhibited moderate to strong correlations to RVSWIRHC, but poor concordance between absolute values. The clinical utility of RVSWIECHO and RVSWIRHC in assessing RV function in relation to PAH prognosis, risk stratification and treatment response remains to be evaluated in a larger clinical context.

Background: In the DETO2X-AMI trial (Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction), we compared supplemental oxygen with ambient air in normoxemic patients presenting with suspected myocardial infarction and found no significant survival benefit at 1 year. However, important secondary end points were not yet available. We now report the prespecified secondary end points cardiovascular death and the composite of all-cause death and hospitalization for heart failure. Methods: In this pragmatic, registry-based randomized clinical trial, we used a nationwide quality registry for coronary care for trial procedures and evaluated end points through the Swedish population registry (mortality), the Swedish inpatient registry (heart failure), and cause of death registry (cardiovascular death). Patients with suspected acute myocardial infarction and oxygen saturation of ≥90% were randomly assigned to receive either supplemental oxygen at 6 L/min for 6 to 12 hours delivered by open face mask or ambient air. Results: A total of 6629 patients were enrolled. Acute heart failure treatment, left ventricular systolic function assessed by echocardiography, and infarct size measured by high-sensitive cardiac troponin T were similar in the 2 groups during the hospitalization period. All-cause death or hospitalization for heart failure within 1 year after randomization occurred in 8.0% of patients assigned to oxygen and in 7.9% of patients assigned to ambient air (hazard ratio, 0.99; 95% CI, 0.84–1.18; P =0.92). During long-term follow-up (median [range], 2.1 [1.0–3.7] years), the composite end point occurred in 11.2% of patients assigned to oxygen and in 10.8% of patients assigned to ambient air (hazard ratio, 1.02; 95% CI, 0.88–1.17; P =0.84), and cardiovascular death occurred in 5.2% of patients assigned to oxygen and in 4.8% assigned to ambient air (hazard ratio, 1.07; 95% CI, 0.87–1.33; P =0.52). The results were consistent across all predefined subgroups. Conclusions: Routine use of supplemental oxygen in normoxemic patients with suspected myocardial infarction was not found to reduce the composite of all-cause mortality and hospitalization for heart failure, or cardiovascular death within 1 year or during long-term follow-up. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01787110.