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dc.contributor.authorSingh, Inderjit
dc.contributor.authorRahaghi, Farbod N
dc.contributor.authorNaeije, Robert
dc.contributor.authorOliveira, Rudolf K F
dc.contributor.authorVanderpool, Rebecca R
dc.contributor.authorWaxman, Aaron B
dc.contributor.authorSystrom, David M
dc.date.accessioned2019-08-26T18:59:27Z
dc.date.available2019-08-26T18:59:27Z
dc.date.issued2019-07
dc.identifier.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/10.1177/2045894019862435en_US
dc.identifier.issn2045-8932
dc.identifier.pmid31218910
dc.identifier.doi10.1177/2045894019862435
dc.identifier.urihttp://hdl.handle.net/10150/633969
dc.description.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.en_US
dc.language.isoenen_US
dc.publisherSAGE PUBLICATIONS INCen_US
dc.rights© The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/).en_US
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/
dc.subjectexercise pulmonary hypertensionen_US
dc.subjectpulmonary arterial hypertensionen_US
dc.subjectright ventricular–pulmonary arterial couplingen_US
dc.titleDynamic right ventricular-pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertensionen_US
dc.typeArticleen_US
dc.identifier.eissn2045-8940
dc.contributor.departmentUniv Arizona Hlth Scien_US
dc.identifier.journalPULMONARY CIRCULATIONen_US
dc.description.noteOpen access articleen_US
dc.description.collectioninformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.en_US
dc.eprint.versionFinal published versionen_US
dc.source.journaltitlePulmonary circulation
refterms.dateFOA2019-08-26T18:59:28Z


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© The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/).
Except where otherwise noted, this item's license is described as © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/).