Dynamic right ventricular–pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertension
Despite 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,...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-07-01
|
| Series: | Pulmonary Circulation |
| Online Access: | https://doi.org/10.1177/2045894019862435 |
| _version_ | 1811329951567183872 |
|---|---|
| author | Inderjit Singh Farbod N. Rahaghi Robert Naeije Rudolf K.F. Oliveira Rebecca R. Vanderpool Aaron B. Waxman David M. Systrom |
| author_facet | Inderjit Singh Farbod N. Rahaghi Robert Naeije Rudolf K.F. Oliveira Rebecca R. Vanderpool Aaron B. Waxman David M. Systrom |
| author_sort | Inderjit Singh |
| collection | DOAJ |
| description | Despite 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 VO 2 %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 VO 2 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. |
| first_indexed | 2024-04-13T15:53:03Z |
| format | Article |
| id | doaj.art-4f3730cd8703420b820d25d42322e23c |
| institution | Directory Open Access Journal |
| issn | 2045-8940 |
| language | English |
| last_indexed | 2024-04-13T15:53:03Z |
| publishDate | 2019-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pulmonary Circulation |
| spelling | doaj.art-4f3730cd8703420b820d25d42322e23c2022-12-22T02:40:47ZengWileyPulmonary Circulation2045-89402019-07-01910.1177/2045894019862435Dynamic right ventricular–pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertensionInderjit Singh0Farbod N. Rahaghi1Robert Naeije2Rudolf K.F. Oliveira3Rebecca R. Vanderpool4Aaron B. Waxman5David M. Systrom6Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USADivision of Pulmonary and Critical Care, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USADepartment of Pathophysiology, Erasmsus Campus, Brussels, BelgiumDivision of Respiratory Diseases, Department of Medicine, Federal University of São Paulo – UNIFESP, São Paulo, BrazilThe University of Arizona Health Science, Tucson, Arizona, USADivision of Pulmonary and Critical Care, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USADivision of Pulmonary and Critical Care, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USADespite 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 VO 2 %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 VO 2 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.https://doi.org/10.1177/2045894019862435 |
| spellingShingle | Inderjit Singh Farbod N. Rahaghi Robert Naeije Rudolf K.F. Oliveira Rebecca R. Vanderpool Aaron B. Waxman David M. Systrom Dynamic right ventricular–pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertension Pulmonary Circulation |
| title | Dynamic right ventricular–pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertension |
| title_full | Dynamic right ventricular–pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertension |
| title_fullStr | Dynamic right ventricular–pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertension |
| title_full_unstemmed | Dynamic right ventricular–pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertension |
| title_short | Dynamic right ventricular–pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertension |
| title_sort | dynamic right ventricular pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertension |
| url | https://doi.org/10.1177/2045894019862435 |
| work_keys_str_mv | AT inderjitsingh dynamicrightventricularpulmonaryarterialuncouplingduringmaximumincrementalexerciseinexercisepulmonaryhypertensionandpulmonaryarterialhypertension AT farbodnrahaghi dynamicrightventricularpulmonaryarterialuncouplingduringmaximumincrementalexerciseinexercisepulmonaryhypertensionandpulmonaryarterialhypertension AT robertnaeije dynamicrightventricularpulmonaryarterialuncouplingduringmaximumincrementalexerciseinexercisepulmonaryhypertensionandpulmonaryarterialhypertension AT rudolfkfoliveira dynamicrightventricularpulmonaryarterialuncouplingduringmaximumincrementalexerciseinexercisepulmonaryhypertensionandpulmonaryarterialhypertension AT rebeccarvanderpool dynamicrightventricularpulmonaryarterialuncouplingduringmaximumincrementalexerciseinexercisepulmonaryhypertensionandpulmonaryarterialhypertension AT aaronbwaxman dynamicrightventricularpulmonaryarterialuncouplingduringmaximumincrementalexerciseinexercisepulmonaryhypertensionandpulmonaryarterialhypertension AT davidmsystrom dynamicrightventricularpulmonaryarterialuncouplingduringmaximumincrementalexerciseinexercisepulmonaryhypertensionandpulmonaryarterialhypertension |