{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T23:57:36Z","timestamp":1785455856387,"version":"3.56.0"},"reference-count":19,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>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\u2013PA coupling and invasive hemodynamics, and evaluated its prognostic significance in precapillary PH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>\n                      Myocardial work indices were measured by 3D echocardiography in patients with well\u2010defined precapillary PH who underwent right heart catheterization within 24\u00a0hours. Patients with poor image quality, significant valvular lesions and associated left heart disease were excluded. Among 61 patients, those with GWW\u00a0\u2265\u00a038\u00a0mmHg\/% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a031) exhibited larger RV end\u2010systolic volume (60 [42\u201371] vs. 42 [35\u201346]\u00a0mL\/m\n                      <jats:sup>2<\/jats:sup>\n                      ,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.009), lower TAPSE (17 [16\u201320] vs. 20 [17\u201323]\u00a0mm,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.04), higher\n                      <jats:italic>E<\/jats:italic>\n                      <jats:sub>a<\/jats:sub>\n                      \u00a0(1.32[0.98\u20131.57] vs. 0.92 [0.64\u20131.29]\u00a0mmHg\/mL,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.02) and higher pulmonary vascular resistance (11.1 [8.1\u201314.2] vs. 5.4 [3.4\u20138.7]WU,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.002). GWW decreased as RV longitudinal strain and RV\u2014PA 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\u20135.7],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/echo.70344","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T11:50:14Z","timestamp":1763466614000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Prognostic Value of Right Ventricular Global Wasted Work in Precapillary Pulmonary Hypertension: A 3D Echocardiographic Study"],"prefix":"10.1111","volume":"42","author":[{"given":"Ashwin","family":"Venkateshvaran","sequence":"first","affiliation":[{"name":"Department of Diagnostics and Intervention, Clinical Physiology Ume\u00e5 University  Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Lindow","sequence":"additional","affiliation":[{"name":"Department of Medicine, Research and Development, Region Kronoberg V\u00e4xj\u00f6 Central Hospital  V\u00e4xj\u00f6 Sweden"},{"name":"Pulmonary Medicine, Allergology, and Palliative Medicine, Department of Clinical Sciences Lund Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca","family":"Jumatate","sequence":"additional","affiliation":[{"name":"Department of Medicine, Central Hospital Kristianstad, Region Sk\u00e5ne Lund University  Lund Sweden"},{"name":"Cardiology, Department of Clinical Sciences Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attila","family":"Kovacs","sequence":"additional","affiliation":[{"name":"Institute For Clinical Data Management, Semmelweis University  Budapest Hungary"},{"name":"Department of Experimental Cardiology and Surgical Techniques Semmelweis University  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Ingvarsson","sequence":"additional","affiliation":[{"name":"Cardiology, Department of Clinical Sciences Lund University  Lund Sweden"},{"name":"Department of Cardiology Sk\u00e5ne University Hospital  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Lindqvist","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention, Clinical Physiology Ume\u00e5 University  Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9509-7199","authenticated-orcid":false,"given":"Anna","family":"Werther Evaldsson","sequence":"additional","affiliation":[{"name":"Cardiology, Department of Clinical Sciences Lund University  Lund Sweden"},{"name":"Department of Cardiology Sk\u00e5ne University Hospital  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01900-2018"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.12.076"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2014-306142"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.119.009047"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2019.04.016"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2024.03.007"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2022.04.058"},{"issue":"38","key":"e_1_2_10_9_1","first-page":"3618","article-title":"2022 ESC\/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension","volume":"43","author":"Humbert M.","year":"2022","journal-title":"European Respiratory Journal"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp297"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jev014"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jev014"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2025.01.006"},{"issue":"4","key":"e_1_2_10_14_1","first-page":"272","article-title":"Echocardiographic Evaluation of Right Ventricular\u2010Arterial Coupling in Pulmonary Hypertension","volume":"10","author":"Todaro M. C.","year":"2020","journal-title":"American Journal of Cardiovascular Disease"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjimp\/qyae099"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(86)90837-8"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-023-03038-y"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-68254-5"},{"issue":"9","key":"e_1_2_10_19_1","first-page":"936","article-title":"New Directions in Right Ventricular Assessment Using 3\u2010Dimensional Echocardiography","volume":"4","author":"Addetia K.","year":"2019","journal-title":"Journal of the American Medical Association Cardiology"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14030668"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70344","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/echo.70344","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70344","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:58:31Z","timestamp":1785452311000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.70344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":19,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1111\/echo.70344"],"URL":"https:\/\/doi.org\/10.1111\/echo.70344","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"2025-08-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70344"}}