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

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 36; no. 4; pp. 671 - 677
• Main Authors: Guo, Di‐Chen, Li, Yi‐Dan, Yang, Yuan‐Hua, Zhu, Wei‐Wei, Sun, Lan‐Lan, Jiang, Wei, Ye, Xiao‐Guang, Cai, Qi‐Zhe, Lu, Xiu‐Zhang
• Format: Journal Article
• Language: English
• Published: United States 01.04.2019
• Subjects: Echocardiography, Stress - methods; exercise capacity; exercise stress echocardiography; Exercise Tolerance - physiology; Female; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - physiopathology; Male; Middle Aged; Prospective Studies; pulmonary hypertension; right ventricular function; Ventricular Dysfunction, Right - complications; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - physiopathology; exercise capacity; exercise stress echocardiography; pulmonary hypertension; right ventricular function
• ISSN: 0742-2822; 1540-8175; 1540-8175
• DOI: 10.1111/echo.14283

Objectives Right ventricular (RV) contractile reserve reflects the ability of RV to accommodate the increased afterload and may play an essential role in the evaluation of precapillary pulmonary hypertension (PH). This study aimed to assess RV contractile reserve based on exercise stress echocardiography (ESE) and to determine the echocardiographic determinants of exercise capacity in patients with precapillary PH. Methods A total of 31 patients with precapillary PH and 15 age‐ and sex‐matched healthy control subjects were prospectively recruited. All subjects underwent ESE to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. Patients with precapillary PH also underwent cardiopulmonary exercise test (CPET), and data pertaining to peak oxygen uptake (peak VO2) and minute ventilation/carbon dioxide production (VE/VCO2) were collected. Results Right ventricular contractile reserve including change in tricuspid annular plane systolic excursion (∆TAPSE), change in RV fractional area change (∆RVFAC), and change in Doppler‐derived tricuspid lateral annular peak systolic velocity (∆S′) was significantly depressed in precapillary PH patients compared with control subjects (P < 0.05). Parameters of RV function and RV contractile reserve were markedly associated with maximal exercise capacity (P < 0.05). ∆RVFAC was an independent predictor of peak VO2 (r2 = 0.601, P < 0.05). Conclusions Assessment of RV contractile reserve facilitates identification of subclinical dysfunction and evaluation of clinical status and severity of precapillary PH. ESE as a noninvasive method may provide a comprehensive clinical assessment and facilitate therapeutic decision‐making for these patients.