Background: Right heart failure (RHF) is associated with a dismal prognosis in patients with pulmonary hypertension (PH). Exercise right heart catheterization may unmask right heart maladaptation as a sign of RHF. We sought to (1) define the normal limits of right atrial pressure (RAP) increase during exercise; (2) describe the right heart adaptation to exercise in PH owing to heart failure with preserved ejection fraction (PH-HFpEF) and in pulmonary arterial hypertension (PAH); and (3) identify the factors associated with right heart maladaptation during exercise. Methods and Results: We analyzed rest and exercise right heart catheterization from patients with PH-HFpEF and PAH. Right heart adaptation was described by absolute or cardiac output (CO)-normalized changes of RAP during exercise. Individuals with noncardiac dyspnea (NCD) served to define abnormal RAP responses (>97.5th percentile). Thirty patients with PH-HFpEF, 30 patients with PAH, and 21 patients with NCD were included. PH-HFpEF were older than PAH, with more cardiovascular comorbidities, and a higher prevalence of severe tricuspid regurgitation (P < .05). The upper limit of normal for peak RAP and RAP/CO slope in NCD were >12 mm Hg and ≥1.30 mm Hg/L/min, respectively. PH-HFpEF had higher peak RAP and RAP/CO slope than PAH (20 mm Hg [16–24 mm Hg] vs 12 mm Hg [9–19 mm Hg] and 3.47 mm Hg/L/min [2.02–6.19 mm Hg/L/min] vs 1.90 mm Hg/L/min [1.01–4.29 mm Hg/L/min], P < .05). A higher proportion of PH-HFpEF had RAP/CO slope and peak RAP above normal (P < .001). Estimated stressed blood volume at peak exercise was higher in PH-HFpEF than PAH (P < .05). In the whole PH cohort, the RAP/CO slope was associated with age, the rate of increase in estimated stressed blood volume during exercise, severe tricuspid regurgitation, and right atrial dilation. Conclusions: Patients with PH-HFpEF display a steeper increase of RAP during exercise than those with PAH. Preload-mediated mechanisms may play a role in the development of exercise-induced RHF.

(2023). Right Heart Adaptation to Exercise in Pulmonary Hypertension: An Invasive Hemodynamic Study [journal article - articolo]. In JOURNAL OF CARDIAC FAILURE. Retrieved from https://hdl.handle.net/10446/253736

Right Heart Adaptation to Exercise in Pulmonary Hypertension: An Invasive Hemodynamic Study

Caravita, Sergio;
2023-01-01

Abstract

Background: Right heart failure (RHF) is associated with a dismal prognosis in patients with pulmonary hypertension (PH). Exercise right heart catheterization may unmask right heart maladaptation as a sign of RHF. We sought to (1) define the normal limits of right atrial pressure (RAP) increase during exercise; (2) describe the right heart adaptation to exercise in PH owing to heart failure with preserved ejection fraction (PH-HFpEF) and in pulmonary arterial hypertension (PAH); and (3) identify the factors associated with right heart maladaptation during exercise. Methods and Results: We analyzed rest and exercise right heart catheterization from patients with PH-HFpEF and PAH. Right heart adaptation was described by absolute or cardiac output (CO)-normalized changes of RAP during exercise. Individuals with noncardiac dyspnea (NCD) served to define abnormal RAP responses (>97.5th percentile). Thirty patients with PH-HFpEF, 30 patients with PAH, and 21 patients with NCD were included. PH-HFpEF were older than PAH, with more cardiovascular comorbidities, and a higher prevalence of severe tricuspid regurgitation (P < .05). The upper limit of normal for peak RAP and RAP/CO slope in NCD were >12 mm Hg and ≥1.30 mm Hg/L/min, respectively. PH-HFpEF had higher peak RAP and RAP/CO slope than PAH (20 mm Hg [16–24 mm Hg] vs 12 mm Hg [9–19 mm Hg] and 3.47 mm Hg/L/min [2.02–6.19 mm Hg/L/min] vs 1.90 mm Hg/L/min [1.01–4.29 mm Hg/L/min], P < .05). A higher proportion of PH-HFpEF had RAP/CO slope and peak RAP above normal (P < .001). Estimated stressed blood volume at peak exercise was higher in PH-HFpEF than PAH (P < .05). In the whole PH cohort, the RAP/CO slope was associated with age, the rate of increase in estimated stressed blood volume during exercise, severe tricuspid regurgitation, and right atrial dilation. Conclusions: Patients with PH-HFpEF display a steeper increase of RAP during exercise than those with PAH. Preload-mediated mechanisms may play a role in the development of exercise-induced RHF.
articolo
2023
Baratto, Claudia; Caravita, Sergio; Dewachter, Céline; Faini, Andrea; Perego, Giovanni Battista; Bondue, Antoine; Senni, Michele; Muraru, Denisa; Badano, Luigi P.; Parati, Gianfranco; Vachiery, Jean-Luc
(2023). Right Heart Adaptation to Exercise in Pulmonary Hypertension: An Invasive Hemodynamic Study [journal article - articolo]. In JOURNAL OF CARDIAC FAILURE. Retrieved from https://hdl.handle.net/10446/253736
File allegato/i alla scheda:
File Dimensione del file Formato  
PIIS1071916423001513.pdf

accesso aperto

Versione: publisher's version - versione editoriale
Licenza: Creative commons
Dimensione del file 582.98 kB
Formato Adobe PDF
582.98 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Aisberg ©2008 Servizi bibliotecari, Università degli studi di Bergamo | Terms of use/Condizioni di utilizzo

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10446/253736
Citazioni
  • Scopus 3
  • ???jsp.display-item.citation.isi??? 2
social impact