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Original research article
Prognostic relevance of the right ventricular myo-mechanical index (RV-MMI) in patients with precapillary pulmonary hypertension
  1. Sebastian Greiner,
  2. Ferdinand Goppelt,
  3. Matthias Aurich,
  4. Hugo A Katus and
  5. Derliz Mereles
  1. Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
  1. Correspondence to Dr Sebastian Greiner; sebastian.greiner{at}


Objective The aim of the prospective New-RV study was to evaluate a parameter for non-invasive quantification of right ventricular (RV) dysfunction in patients with precapillary pulmonary hypertension (PH) that yields prognostic information and is applicable in daily clinical routine.

Methods Sixty-five consecutive patients with precapillary PH under guideline conform therapy (43 women, 22 men) underwent clinical assessment, serological testing, as well as a comprehensive transthoracic echocardiography including strain imaging and a detailed assessment of RV haemodynamics.

Results The mean follow-up time was 844 days. Sixteen patients died during clinical follow-up. Right ventricular myo-mechanical index (RV-MMI) was calculated by right atrial size, mean RV pressure gradient and strain imaging of the RV free wall, and was measurable in all examinations. RV-MMI was tested for its diagnostic accuracy (sensitivity of 88% and specificity of 73% for an optimal cut-off value of ≤0.31 mm Hg*%; area under the curve=0.85), as well as its predictive value (HR=3.3, 95% CI 1.6 to 7.0, p<0.001), and was compared in detail with established parameters. RV-MMI and N-terminal pro-brain natriuretic peptide (NTproBNP)were independent predictors of survival (HR=2.9, 95% CI 1.4 to 6.2, p=0.006; and HR=2.6, 95% CI 1.5 to 4.6, p=0.001, respectively).

Conclusion In a cohort of patients with precapillary PH, the RV-MMI differentiates the outcome of patients better than other available non-invasive parameters of RV function by preload and afterload adjusted quantification.

Trial registration number NCT01230294.

  • right ventricular function
  • pulmonary hypertension
  • survival
  • transthoracic (Doppler) echocardiography
  • strain imaging

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  • Contributors The echocardiographic examinations were carried out by SG, MA and DM. FG and SG conducted the offline measurements, acquisition of clinical data and statistical analysis. SG, FG, MA, HAK and DM contributed substantially to study design and organisation, as well as preparation of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • -- -- (see "funding" above)

  • Competing interests None declared.

  • Patient consent Written, informed consent was obtained from all patients.

  • Ethics approval The study was carried out prospectively after approval by the Ethics Committee of the University of Heidelberg, in concordance with the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement The article, as well as the data presented, is original, does not infringe upon any copyright or other proprietary right of any third party, is not under consideration by another journal and has not been previously published.

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