Abnormal right ventricular-pulmonary artery coupling with exercise in heart failure with preserved ejection fraction
Abnormal right ventricular-pulmonary artery coupling with exercise in heart failure with preserved ejection fraction
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DOI：
10.1093/eurheartj/ehw241
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发表时间：
2016-11-14
影响因子：
39.3
通讯作者：
Olson, Thomas P.
中科院分区：
文献类型：
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作者：
Borlaug, Barry A.;Kane, Garvan C.;Olson, Thomas P.
运动不耐受在射血分数正常的心力衰竭患者中很常见。右心室（RV）功能障碍已被证明在休息HFpEF，但很少有数据是关于动态RV-肺动脉（PA）耦合在exercise.Methods和结果主题HFpEF（n = 50）和对照组（n = 24）前瞻性地进行了侵入性心肺运动试验，使用高保真微压计导管沿着与RV和左心室（LV）的同时评估。通过超声心动图进行力学分析。与对照组相比，HFpEF受试者在静息状态下显示保留的RV收缩和舒张力学（RV '和e'），受损的LV '和e'，较高的双心室充盈压和较高的肺动脉压。运动时，HFpEF受试者的每搏输出量、心率和心输出量（CO）增加较少，CO相对于O-2消耗量（VO 2）的增加较钝。与对照组相比，HFpEF组运动时RV收缩和舒张功能的增强受损。HFpEF中，与更大的静脉缺氧相关的血流动力学诱导的PA血管舒张减少。在双心室充盈压和限制CO储备的升高与心室力学的RV和LV在stress.Conclusions除了有限的LV储备，HFpEF患者显示受损的RV储备在运动过程中，这是与高充盈压和CO反应不足的异常增强密切相关。这些发现强调了HFpEF中双心室功能障碍的重要性，并表明针对左右心心肌储备的新疗法可能有效改善临床状态。
Background Exercise intolerance is common in people with heart failure and preserved ejection fraction (HFpEF). Right ventricular (RV) dysfunction has been shown at rest in HFpEF but little data are available regarding dynamic RV-pulmonary artery (PA) coupling during exercise.Methods and results Subjects with HFpEF (n = 50) and controls (n = 24) prospectively underwent invasive cardiopulmonary exercise testing using high-fidelity micromanometer catheters along with simultaneous assessment of RV and left ventricular (LV) mechanics by echocardiography. Compared with controls at rest, subjects with HFpEF displayed preserved RV systolic and diastolic mechanics (RVs' and e'), impaired LVs' and e', higher biventricular filling pressures, and higher pulmonary artery pressures. On exercise, subjects with HFpEF displayed less increase in stroke volume, heart rate, and cardiac output (CO), with blunted increase in CO relative to O-2 consumption (VO2). Enhancement in RV systolic and diastolic function on exercise was impaired in HFpEF compared with controls. Exercise-induced PA vasodilation was reduced in HFpEF in correlation with greater venous hypoxia. Elevations in biventricular filling pressures and limitations in CO reserve were strongly correlated with abnormal enhancement in ventricular mechanics in the RV and LV during stress.Conclusions In addition to limited LV reserve, patients with HFpEF display impaired RV reserve during exercise that is associated with high filling pressures and inadequate CO responses. These findings highlight the importance of biventricular dysfunction in HFpEF and suggest that novel therapies targeting myocardial reserve in both the left and right heart may be effective to improve clinical status.