title: 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.
  
  
  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.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Yasushige
authors.initials: Y
authors.lastname: Shingu
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Matsui
mesh_terms: D016279:Atrial Function, Left; D004452:Echocardiography; D006439:Hemodynamics; D006801:Humans; D007564:Japan; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D016277:Ventricular Function, Left; D017725:Ventricular Pressure