TY - JOUR
T1 - Exercise right ventricular ejection fraction predicts right ventricular contractile reserve
AU - Ireland, Catherine G.
AU - Damico, Rachel L.
AU - Kolb, Todd M.
AU - Mathai, Stephen C.
AU - Mukherjee, Monica
AU - Zimmerman, Stefan L.
AU - Shah, Ami A.
AU - Wigley, Fredrick M.
AU - Houston, Brian A.
AU - Hassoun, Paul M.
AU - Kass, David A.
AU - Tedford, Ryan J.
AU - Hsu, Steven
N1 - Publisher Copyright:
© 2021 International Society for Heart and Lung Transplantation
PY - 2021/6
Y1 - 2021/6
N2 - BACKGROUND: Right ventricular (RV) contractile reserve shows promise as an indicator of occult RV dysfunction in pulmonary vascular disease. We investigated which measure of RV contractile reserve during exercise best predicts occult RV dysfunction and clinical outcomes. METHODS: We prospectively studied RV contractile reserve in 35 human subjects referred for right heart catheterization for known or suspected pulmonary hypertension. All underwent cardiac magnetic resonance imaging, echocardiography, and supine invasive cardiopulmonary exercise testing with concomitant RV pressure-volume catheterization. Event-free survival was prospectively adjudicated from time of right heart catheterization for a 4-year follow-up period. RESULTS: RV contractile reserve during exercise, as measured by a positive change in end-systolic elastance (Ees) during exertion, was associated with elevation in pulmonary pressures but preservation of RV volumes. Lack of RV reserve, on the other hand, was tightly coupled with acute RV dilation during exertion (R2 = 0.76, p< 0.001). RV Ees and dilation changes each predicted resting RV-PA dysfunction. RV ejection fraction during exercise, which captured exertional changes in both RV Ees and RV dilation, proved to be a robust surrogate for RV contractile reserve. Reduced exercise RV ejection fraction best predicted occult RV dysfunction among a variety of resting and exercise RV measures, and was also associated with clinical worsening. CONCLUSIONS: RV ejection fraction during exercise, as an index of RV contractile reserve, allows for excellent identification of occult RV dysfunction, more so than resting measures of RV function, and may predict clinical outcomes as well.
AB - BACKGROUND: Right ventricular (RV) contractile reserve shows promise as an indicator of occult RV dysfunction in pulmonary vascular disease. We investigated which measure of RV contractile reserve during exercise best predicts occult RV dysfunction and clinical outcomes. METHODS: We prospectively studied RV contractile reserve in 35 human subjects referred for right heart catheterization for known or suspected pulmonary hypertension. All underwent cardiac magnetic resonance imaging, echocardiography, and supine invasive cardiopulmonary exercise testing with concomitant RV pressure-volume catheterization. Event-free survival was prospectively adjudicated from time of right heart catheterization for a 4-year follow-up period. RESULTS: RV contractile reserve during exercise, as measured by a positive change in end-systolic elastance (Ees) during exertion, was associated with elevation in pulmonary pressures but preservation of RV volumes. Lack of RV reserve, on the other hand, was tightly coupled with acute RV dilation during exertion (R2 = 0.76, p< 0.001). RV Ees and dilation changes each predicted resting RV-PA dysfunction. RV ejection fraction during exercise, which captured exertional changes in both RV Ees and RV dilation, proved to be a robust surrogate for RV contractile reserve. Reduced exercise RV ejection fraction best predicted occult RV dysfunction among a variety of resting and exercise RV measures, and was also associated with clinical worsening. CONCLUSIONS: RV ejection fraction during exercise, as an index of RV contractile reserve, allows for excellent identification of occult RV dysfunction, more so than resting measures of RV function, and may predict clinical outcomes as well.
KW - exercise
KW - heart ventricles
KW - pulmonary hypertension
UR - http://www.scopus.com/inward/record.url?scp=85103049970&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85103049970&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2021.02.005
DO - 10.1016/j.healun.2021.02.005
M3 - Article
C2 - 33752973
AN - SCOPUS:85103049970
SN - 1053-2498
VL - 40
SP - 504
EP - 512
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 6
ER -