Echocardiography during preload stress for evaluation of right ventricular contractile reserve and exercise capacity in pulmonary hypertension

Abstract

Objectives Pulmonary hypertension (PH) is characterized by marked and sustained elevation of pulmonary vascular resistance and pulmonary artery pressure, and subsequent right‐sided heart failure. Right ventricular (RV) function and exercise capacity have been recognized as important prognostic factors for PH. Our aim was to investigate RV contractile reserve and exercise capacity during a leg‐positive pressure (LPP) maneuver. Methods The study population comprised 43 PH patients and 17 normal controls. All patients underwent echocardiography at rest and during LPP stress. Exercise capacity was assessed by 6‐minute walk distance for PH patients. RV relative wall thickness was calculated from dividing by RV free wall thickness by basal RV linear dimensions at end‐diastole. RV function was calculated by averaging peak speckle‐tracking longitudinal strain from the RV free wall. RV contractile reserve was assessed as the difference in RV free wall strain at rest and during LPP stress. Changes in left ventricular stroke volume (ΔSV) during LPP stress were also calculated. Results ΔSV and RV contractile reserve of PH patients were significantly lower than of controls (3.6 ± 6.0 mL vs 8.5 ± 2.3 mL, and 8.2 ± 11.9% vs 14.5 ± 6.6%; both P < 0.01). RV contractile reserve of PH patients with ΔSV <3.3 mL was significantly lower than of PH patients with ΔSV >3.3 mL (3.9 ± 13.2% vs 12.3 ± 8.9%; P = 0.02). ΔSV had also significant correlation with 6‐minute walk distance (r = 0.42, P = 0.006). Multivariate regression analysis showed that RV relative wall thickness was an independent determinant parameter of ΔSV during LPP stress for PH patients (β = 3.2, P = 0.003). Conclusions Preload stress echocardiography in response to LPP maneuver, a noninvasive and easy‐to‐use procedure for routine clinical use, proved to be useful for the assessment of RV contractile reserve and exercise capacity of PH patients.

Preload Dependency of 2D Right Ventricle Speckle Tracking Echocardiography Parameters in Healthy Volunteers: A Prospective Pilot Study

“…However, the strain analysis was not performed in the RV apical view but by with analysis of the six segments in a classical four-chamber view. Sano et al [ 16 ] evaluated the RV contractile reserve using a preload stress echocardiography in patients with pulmonary hypertension compared to healthy volunteers. They reported that RV free wall strain (assess in the RV-focused apical four-chamber view) increased significantly (+3.5%) as well as SV (+8.4 mL) in the healthy volunteer’s group (15).…”

Right Heart Size and Right Ventricular Reserve in Pulmonary Hypertension: Impact on Management and Prognosis

“…RV free wall longitudinal strain, which is an indicator of RV function at rest, is calculated as the mean of the RV lateral basal, mid, and apical segments, with exclusion of the septal segments. In one study, RV contractile reserve was assessed as the difference in RV free wall strain at rest and during a leg-positive pressure stress [24]. In this study of 43 pulmonary hypertension patients, RV contractile reserve was significantly lower in patients with changes in left ventricular stroke volume < 3.3 mL.…”

Mitral E‐wave to stroke volume ratio displays stronger diagnostic performance to identify elevated left ventricular filling pressures than mitral E/e’ during passive leg lift: A cross‐sectional study employing simultaneous echocardiography and catheterization

“…We suggest that the E/SV ratio may demonstrate value to identify patients with elevated PCWP under PLL. Earlier studies show a lack of increase in SV during PLL both in patients with PH 14 and in HFpEF. 15 We demonstrate similar findings, suggesting that the inability to augment SV may be owing to the LV operating on the plateau limb of the Frank-Starling curve.…”