Right ventricular function and its coupling to pulmonary circulation predicts exercise tolerance in systolic heart failure

被引:18
|
作者
Legris, Valery [1 ,2 ]
Thibault, Bernard [1 ,2 ]
Dupuis, Jocelyn [1 ,2 ]
White, Michel [1 ,2 ]
Asgar, Anita W. [1 ,2 ]
Fortier, Annik [3 ]
Pitre, Celine [1 ,2 ]
Bouabdallaoui, Nadia [1 ,2 ]
Henri, Christine [1 ,2 ]
O'Meara, Eileen [1 ,2 ]
Ducharme, Anique [1 ,2 ]
机构
[1] Montreal Heart Inst, Dept Med, Montreal, PQ, Canada
[2] Univ Montreal, Montreal, PQ, Canada
[3] Montreal Hlth Inst Coordinating Ctr MHICC, Montreal, PQ, Canada
来源
ESC HEART FAILURE | 2022年 / 9卷 / 01期
关键词
Right ventricular function; RV to pulmonary arterial coupling; Heart failure with reduced ejection fraction; Exercise tolerance; Echocardiography; EJECTION FRACTION; EUROPEAN ASSOCIATION; AMERICAN SOCIETY; RESYNCHRONIZATION THERAPY; CONTRACTILE FUNCTION; DIASTOLIC FUNCTION; CAPACITY; ECHOCARDIOGRAPHY; RECOMMENDATIONS; PERFORMANCE;
D O I
10.1002/ehf2.13726
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Right ventricular (RV) dysfunction, pulmonary hypertension, and exercise intolerance have prognostic values, but their interrelation is not fully understood. We investigated how RV function alone and its coupling with pulmonary circulation (RVPA) predict cardio-respiratory fitness in patients with heart failure and reduced ejection fraction (HFrEF). Methods and results The Evaluation of Resynchronization Therapy for Heart Failure (EARTH) study included 205 HFrEF patients with narrow (n = 85) and prolonged (n = 120) QRS duration undergoing implantable cardioverter defibrillator implantation. All patients underwent a comprehensive evaluation with exercise tolerance tests and echocardiography. We investigated the correlations at baseline between RV parameters (size, function [tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RV-FAC), and RV myocardial performance index (RV-MPI)], pulmonary artery systolic pressure (PASP), and tricuspid regurgitation}; left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume index (LVEDVi), and left atrial volume index (LAVi); and cardiopulmonary exercise test (CPET) [peak VO2, minute ventilation/carbon dioxide production (VE/VCO2), 6 min walk distance (6MWD), and submaximal exercise duration (SED)]. We also studied the relationship between RV-PA coupling (TAPSE/PASP ratio) and echocardiographic parameters in patients with both data available. Univariate and multivariate linear regression models were used. Patients enrolled in EARTH (overall population) were mostly male (73.2%), mean age 61.0 +/- 9.8 years, New York Heart Association class II-III (87.8%), mean LVEF of 26.6 +/- 7.7%, and reduced peak VO2 (15.1 +/- 4.6 ml/kg/min). Of these, 100 had both TAPSE and PASP available (TAPSE/PASP population): they exhibited higher BNP, wider QRS duration, larger LVEDVi, with more having tricuspid regurgitation compared with the 105 patients for whom these values were not available (all P < 0.05). RV-FAC (beta = 7.5), LAVi (beta = -0.1), and sex (female, beta = -1.9) predicted peak VO2 in the overall population (all P = 0.01). When available, TAPSE/PASP ratio was the only echocardiographic parameter associated with peak VO2 (beta = 6.8; P < 0.01), a threshold 50.45 predicting a peak VO2 <= 14 ml/kg/min (0.39 for VO2 <= 12). RV-MPI was the only echocardiographic parameter associated with ventilatory inefficiency (VE/VCO2) and 6MWD = 21.9 and beta = -69.3, respectively, both P < 0.01) in the overall population. In presence of TAPSE/PASP, it became an important predictor for those two CPET (beta = -18.0 and beta = 72.4, respectively, both P < 0.01), together with RV-MPI (beta = 18.5, P < 0.01) for VE/VCO2. Tricuspid regurgitation predicted SED (beta = -3.2, P = 0.03). Conclusions Right ventricular function assessed by echocardiography (RV-MPI and RV-FAC) is closely associated with exercise tolerance in patients with HFrEF. When the TAPSE/PASP ratio is available, this marker of RV-PA coupling becomes the stronger echocardiographic predictor of exercise capacity in this population, highlighting its potential role as a screening tool to identify patients with reduced exercise capacity and potentially triage them to formal peak VO2 and/or evaluation for advanced HF therapies.
引用
收藏
页码:450 / 464
页数:15
相关论文
共 50 条
  • [1] Right ventricular function and its coupling with the pulmonary circulation in acute heart failure
    Barki, M.
    Losito, M.
    Caracciolo, M. M.
    Bandera, F.
    Rovida, M.
    Alfonzetti, E.
    Guazzi, M.
    [J]. EUROPEAN HEART JOURNAL, 2020, 41 : 1218 - 1218
  • [2] PHENOTYPING RIGHT VENTRICULAR FUNCTION AND ITS COUPLING WITH THE PULMONARY CIRCULATION IN ACUTE HEART FAILURE
    Barki, Monica
    Losito, Maurizio
    Caracciolo, Michela Maria
    Bandera, Francesco
    Rovida, Marina
    Alfonzetti, Eleonora
    Guazzi, Marco
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2020, 75 (11) : 1695 - 1695
  • [3] RIGHT VENTRICULAR FUNCTION COUPLING TO THE PULMONARY CIRCULATION PREDICTS EXERCISE TOLERANCE IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION: INSIGHT FROM THE EVALUATION OF RESYNCHRONIZATION THERAPY FOR HEART FAILURE (EARTH) TRIAL
    Legris, Valery
    Thibault, Bernard
    Dupuis, Jocelyn
    White, Michel
    Fortier, Annik
    Henri, Christine
    O'Meara, Eileen
    Ducharme, Anique
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2020, 75 (11) : 825 - 825
  • [4] Right Ventricular Function Coupling to the Pulmonary Circulation Predicts Exercise Tolerance in Patients with Heart Failure and Reduced Ejection Fraction. Insight from the Evaluation of Resynchronization Therapy for Heart Failure (EARTH) Trial
    Legris, V.
    Thibault, B.
    Dupuis, J.
    White, M.
    Fortier, A.
    Henri, C.
    O'Meara, E.
    Ducharme, A.
    [J]. JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2020, 39 (04): : S35 - S36
  • [5] Predictors of right ventricular-pulmonary circulation coupling improvement in heart failure
    Santiago-Vacas, E.
    Domingo, M.
    Codina, P.
    Cediel, G.
    Spitaleri, G.
    Zamora, E.
    Gual, F.
    Teis, A.
    Santesmases, J.
    Velayos, P.
    Pulido, A.
    Crespo, E.
    Nunez, J.
    Lupon, J.
    Bayes-Genis, A.
    [J]. EUROPEAN JOURNAL OF HEART FAILURE, 2021, 23 : 82 - 83
  • [6] Event-prediction of Right Ventricular to Pulmonary Circulation Coupling Measured During Exercise in Patients With Heart Failure
    Sugimoto, Tadafumi
    Bandera, Francesco
    Generati, Greta
    Alfonzetti, Eleonora
    Labate, Valentina
    Guazzi, Marco
    [J]. CIRCULATION, 2019, 140
  • [7] Event-prediction of right ventricular to pulmonary circulation coupling measured during exercise in patients with heart failure
    Sugimoto, T.
    Boveri, S.
    Bandera, F.
    Barletta, M.
    Alfonzetti, E.
    Guazzi, M.
    [J]. EUROPEAN HEART JOURNAL, 2020, 41 : 887 - 887
  • [8] Assessment of Right Ventricular to Pulmonary Circulation Uncoupling at Peak Exercise in Heart Failure Patients by the Relationship Between Pulmonary Systolic Pressure vs Right Ventricular Longitudinal Strain
    Donghi, Valeria
    Carbone, Francesco
    Labate, Valentina
    Generati, Greta
    Pellegrino, Marta
    Alfonzetti, Eleonora
    Bandera, Francesco
    Guazzi, Marco
    [J]. CIRCULATION, 2015, 132
  • [9] Association of compromised right ventricular function with reduced exercise tolerance predicts survival in patients with chronic heart failure
    Cucco, C.
    Scardovi, A. B.
    Galeotti, G. G.
    Simioniuc, A.
    Scali, M. C.
    Ghio, S.
    Rossi, A.
    Temporelli, P. L.
    Marzilli, M.
    Dini, F. L.
    [J]. EUROPEAN HEART JOURNAL, 2015, 36 : 1171 - 1171
  • [10] Right ventricular systolic function and exercise capacity in chronic systolic heart failure: right ventricular mechanics outperform conventional echocardiographic parameters
    Schuster, A.
    Borowski, A. G.
    Thomas, J. D.
    Tang, W. H.
    [J]. EUROPEAN HEART JOURNAL, 2014, 35 : 883 - 883