Right ventricular dyssynchrony and exercise capacity in idiopathic pulmonary arterial hypertension

Abstract

Survival in patients with pulmonary arterial hypertension (PAH) is determined by right ventricular (RV) function adaptation to afterload. How altered RV function impacts on exercise capacity in PAH is not exactly known.104 idiopathic PAH (IPAH) patients aged 52±14 years underwent a diagnostic right heart catheterisation, a comprehensive echocardiography including two-dimensional speckle tracking for RV dyssynchrony evaluation and a cardiopulmonary exercise test. Multivariate analyses were performed to identify independent predictors of peak oxygen uptake (peak ' ).A first multivariate analysis of only resting haemodynamic variables identified cardiac index, right atrial (RA) pressure and pulmonary arterial compliance as independent predictors, with low predictive capacity (r=0.31; p<0.001). A second multivariate analysis model which considered only echocardiographic parameters but without RV dyssynchrony, identified RV fractional area change (FAC) and RA area as independent predictors with still low predictivity (r=0.35; p<0.001). Adding RV dyssynchrony to the second model increased its predictivity (r=0.48; p<0.001). Repetition of the three multivariate analyses in patients with preserved RVFAC confirmed that inclusion of RV dyssynchrony results in the highest predictive capability of peak ' (r=0.53; p=0.001).A comprehensive echocardiography with speckle tracking-derived assessment of the heterogeneity of RV contraction improves the prediction of aerobic exercise capacity in IPAH.

Right ventricular dyssynchrony during hypoxic breathing but not during exercise in healthy subjects: a speckle tracking echocardiography study

“…An increased RV-SD4 at rest has been previously reported to predict a decreased exercise capacity in severe PH (Badagliacca et al, 2017a) in relation to altered RV pump function (Badagliacca et al, 2015a;Kalogeropoulos et al, 2008). An increased RV-SD4 at rest has been previously reported to predict a decreased exercise capacity in severe PH (Badagliacca et al, 2017a) in relation to altered RV pump function (Badagliacca et al, 2015a;Kalogeropoulos et al, 2008).…”

“…Actually RV-SD4 may be higher than the upper limit of normal, taken as 20-22 ms, in no more than 50-60% of patients and stabilize around 27-30 ms in severe PH (Badagliacca et al, 2015a(Badagliacca et al, , 2015b(Badagliacca et al, , 2017a. Thus while RV-SD4 is correlated to RV function (Badagliacca et al, 2015a(Badagliacca et al, , 2015bKalogeropoulos et al, 2008;Lamia et al, 2017), functional state and exercise capacity (Badagliacca et al, 2015a(Badagliacca et al, , 2015b(Badagliacca et al, , 2017aKalogeropoulos et al, 2008;Meris et al, 2010), and survival (Badagliacca et al, 2015b), it has been found either to correlate but loosely or not at all with mPAP, PVR or pulmonary arterial compliance ( For other abbreviations, see Figure 1 TA B L E 3 Right ventricular dyssynchrony, pulmonary vascular resistance and mean pulmonary arterial pressure of study population excluding subjects with QRS >100 ms RV-SD4 (ms) 10 ± 4 1 2 ± 5 1 3 ± 6 1 3± 6 1 3± 5 1 2 ± 5 1 2 ± 4 mPAP, mean pulmonary artery pressure; PVR, pulmonary vascular resistance; RV-SD4, standard deviation of the times to peak systolic strain of the four mid and basal right ventricular segments; S pO 2 , percutaneous saturation of oxygen; WU, Wood units. * P < 0.05 vs. baseline.…”

“…Magnetic resonance imaging (MRI), tissue Doppler imaging and speckle tracking echocardiography studies have shown that severe PH is associated not only with a prolonged RV contraction resulting in 'post-systolic shortening' Marcus et al, 2008), but also with regional heterogeneity of RV contraction, or 'dyssynchrony' (Badagliacca et al, 2015a(Badagliacca et al, , 2015b(Badagliacca et al, , 2017aKalogeropoulos et al, 2008;Meris et al, 2010;Murata et al, 2017;Smith et al, 2014). Magnetic resonance imaging (MRI), tissue Doppler imaging and speckle tracking echocardiography studies have shown that severe PH is associated not only with a prolonged RV contraction resulting in 'post-systolic shortening' Marcus et al, 2008), but also with regional heterogeneity of RV contraction, or 'dyssynchrony' (Badagliacca et al, 2015a(Badagliacca et al, , 2015b(Badagliacca et al, , 2017aKalogeropoulos et al, 2008;Meris et al, 2010;Murata et al, 2017;Smith et al, 2014).…”

“…This has intensified research on the right ventricle with imaging . Magnetic resonance imaging (MRI), tissue Doppler imaging and speckle tracking echocardiography studies have shown that severe PH is associated not only with a prolonged RV contraction resulting in 'post-systolic shortening' Marcus et al, 2008), but also with regional heterogeneity of RV contraction, or 'dyssynchrony' (Badagliacca et al, 2015a(Badagliacca et al, , 2015b(Badagliacca et al, , 2017aKalogeropoulos et al, 2008;Meris et al, 2010;Murata et al, 2017;Smith et al, 2014). RV dyssynchrony has been reported to be associated with more severe disease, decreased exercise capacity and shorter survival in PH patients (Badagliacca et al, 2015a(Badagliacca et al, , 2015b(Badagliacca et al, , 2017aMurata et al, 2017).…”

Influence of impaired right ventricular contractile reserve on exercise capacity in patients with precapillary pulmonary hypertension: A study with exercise stress echocardiography

“…Since exercise capacity of patients with precapillary PH is largely affected by the cardiac output, it is necessary to study the impact of RV contractile reserve on exercise capacity. In a study by Badagliacca et al, resting RHC parameters (cardiac index, right atrial pressure, and pulmonary arterial compliance), resting RVFAC, and right atrial area were shown to be independent predictors of peak VO 2 . However, little information is available on the association between RV function under stress conditions, especially RV contractile reserve with exercise capacity.…”