Did we misunderstand how to calculate total stroke work in mitral regurgitation by echocardiography?

Abstract

Background: Total stroke work (TSW) is used for the estimation of cardiac efficiency in mitral regurgitation (MR). We should be cautious about the interpretation of this parameter, especially when it is assessed by non-invasive methods such as echocardiography. Methods and Results: For the calculation of regurgitant stroke work, regurgitant volume is usually multiplied by left atrial (LA) pressure. However, by considering the left ventricular (LV) pressure-volume loop, it would be more appropriate to multiply regurgitant volume and the LV pressure, not the atrial one. Conclusions: We might underestimate TSW when we use LA pressure for the estimation of regurgitant stroke work.