Dynamic right ventricular-pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertension
Rahaghi, Farbod N
Oliveira, Rudolf K F
Vanderpool, Rebecca R
Waxman, Aaron B
Systrom, David M
AffiliationUniv Arizona Hlth Sci
Keywordsexercise pulmonary hypertension
pulmonary arterial hypertension
right ventricular–pulmonary arterial coupling
MetadataShow full item record
PublisherSAGE PUBLICATIONS INC
CitationSingh, I., Rahaghi, F. N., Naeije, R., Oliveira, R. K. F., Vanderpool, R. R., Waxman, A. B., & Systrom, D. M. (2019). Dynamic right ventricular–pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertension. Pulmonary Circulation. https://doi.org/10.1177/2045894019862435
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AbstractDespite recent advances, the prognosis of pulmonary hypertension (PH) remains poor. While the initial insult in PH implicates the pulmonary vasculature, the functional state, exercise capacity, and survival of such patients are closely linked to right ventricular (RV) function. In the current study, we sought to investigate the effects of maximum incremental exercise on the matching of RV contractility and afterload (i.e. right ventricular-pulmonary arterial [RV-PA] coupling) in patients with exercise PH (ePH) and pulmonary arterial hypertension (PAH). End-systolic elastance (Ees), pulmonary arterial elastance (Ea), and RV-PA coupling (Ees/Ea) were determined using single-beat pressure-volume loop analysis in 40 patients that underwent maximum invasive cardiopulmonary exercise testing. Eleven patients had ePH, nine had PAH, and 20 were age-matched controls. During exercise, the impaired exertional contractile reserve in PAH was associated with blunted stroke volume index (SVI) augmentation and reduced peak oxygen consumption (peak VO2 %predicted). Compared to PAH, ePH demonstrated increased RV contractility in response to increasing RV afterload during exercise; however, this was insufficient and resulted in reduced peak RV-PA coupling. The dynamic RV-PA uncoupling in ePH was associated with similarly blunted SVI augmentation and peak VO2 as PAH. In conclusion, dynamic rest-to-peak exercise RV-PA uncoupling during maximum exercise blunts SV increase and reduces exercise capacity in exercise PH and PAH. In ePH, the insufficient increase in RV contractility to compensate for increasing RV afterload during maximum exercise leads to deterioration of RV-PA coupling. These data provide evidence that even in the early stages of PH, RV function is compromised.
NoteOpen access article
VersionFinal published version
- Sex-related Differences in Dynamic Right Ventricular-Pulmonary Vascular Coupling in Heart Failure With Preserved Ejection Fraction.
- Authors: Singh I, Oliveira RKF, Heerdt PM, Pari R, Systrom DM, Waxman AB
- Issue date: 2021 Jan 1
- Right Ventricular-Arterial Uncoupling During Exercise in Heart Failure With Preserved Ejection Fraction: Role of Pulmonary Vascular Dysfunction.
- Authors: Singh I, Rahaghi FN, Naeije R, Oliveira RKF, Systrom DM, Waxman AB
- Issue date: 2019 Nov
- The effects of exercise on right ventricular contractility and right ventricular-arterial coupling in pulmonary hypertension.
- Authors: Spruijt OA, de Man FS, Groepenhoff H, Oosterveer F, Westerhof N, Vonk-Noordegraaf A, Bogaard HJ
- Issue date: 2015 May 1
- Right Ventricular Functional Reserve in Pulmonary Arterial Hypertension.
- Authors: Hsu S, Houston BA, Tampakakis E, Bacher AC, Rhodes PS, Mathai SC, Damico RL, Kolb TM, Hummers LK, Shah AA, McMahan Z, Corona-Villalobos CP, Zimmerman SL, Wigley FM, Hassoun PM, Kass DA, Tedford RJ
- Issue date: 2016 Jun 14
- Right ventriculo-arterial uncoupling and impaired contractile reserve in obese patients with unexplained exercise intolerance.
- Authors: McCabe C, Oliveira RKF, Rahaghi F, Faria-Urbina M, Howard L, Axell RG, Priest AN, Waxman AB, Systrom DM
- Issue date: 2018 Jul
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