Right ventricular function is central to outcomes in PAH. A study in European Heart Journal – Cardiovascular Imaging evaluated novel echocardiographic indices of right ventricular myocardial work (RVMW) for their ability to predict haemodynamics and identify high-risk profiles in PAH patients.

A prospective cohort of 58 PAH patients (mean age 58 ± 14 years; 72% female) with confirmed disease by right heart catheterization (RHC) and echocardiographic images was analyzed. Patients’ risk profiles were assigned according to guideline criteria. RVMW indices, including RVGWW and right ventricular global work efficiency, were measured and correlated with mPAP, PVR, SVI, and PAC.

RVGWW was significantly elevated and right ventricular global work efficiency decreased in high-risk patients. RVGWW correlated with mPAP (R = 0.46; P < 0.001), PVR (R = 0.51; P < 0.001), SVI (R = −0.3; P = 0.024), and PAC (R = −0.31; P = 0.02). Specific thresholds predicted haemodynamic impairments: <60 mmHg% indicated low probability of PVR >5 Wood units (WU); 83–84 mmHg% indicated high probability of PAC <2.3 mL/mmHg and mPAP >40 mmHg; >120 mmHg% indicated SVI <31 mL/m². RVGWW >175 mmHg% identified patients at high mortality risk.

These findings indicate that RVGWW is a strong echocardiographic marker of adverse haemodynamics and high-risk status in PAH.