Assessment of right ventricular reserve utilizing exercise provocation in systemic sclerosis
| Autor: | Fredrick M. Wigley, Ami A. Shah, Susan A. Mayer, Steven Hsu, Monica Mukherjee, Valentina Mercurio, Paul M. Hassoun, Laura K. Hummers, David A. Kass, Ryan J. Tedford, Stephen C. Mathai |
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| Přispěvatelé: | Mukherjee, M., Mercurio, V., Hsu, S., Mayer, S. A., Mathai, S. C., Hummers, L. K., Kass, D. A., Hassoun, P. M., Wigley, F. M., Tedford, R. J., Shah, A. A. |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Supine position Heart Ventricles Hypertension Pulmonary Ventricular Dysfunction Right Exercise stre Provocation test Predictive Value of Test Longitudinal strain 030204 cardiovascular system & hematology Article Pulmonary hypertension Heart Ventricle Contractility Systemic sclerosi 03 medical and health sciences Basal (phylogenetics) 0302 clinical medicine Afterload Predictive Value of Tests Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Exercise Subclinical infection 030203 arthritis & rheumatology Scleroderma Systemic business.industry medicine.disease Blood pressure Echocardiography Ventricular Function Right Cardiology Right ventricle Cardiology and Cardiovascular Medicine business Human |
| Zdroj: | Int J Cardiovasc Imaging |
| ISSN: | 1573-0743 1569-5794 |
| Popis: | PURPOSE: Right ventricular (RV) capacity to adapt to increased afterload is the main determinant of outcome in pulmonary hypertension (PH), a common morbidity seen in systemic sclerosis (SSc). We hypothesized that supine bicycle echocardiography (SBE), coupled with RV longitudinal systolic strain (RVLSS), improves detection of limitations in RV reserve in SSc. METHODS: 56 SSc patients were prospectively studied during SBE with RV functional parameters compared at rest and peak stress. We further dichotomized patients based on resting RV systolic pressure (RVSP) to determine the effects of load on contractile response. RESULTS: Our pooled cohort analysis revealed reduced global RVLSS at rest (−16.2 ± 3.9%) with normal basal contractility (−25.6 ± 7.7%) and relative hypokinesis of the midventricular (−14.1 ± 6.0%) and apical (−8.9 ± 5.1%) segments. With exercise, global RVLSS increased significantly (p=0.0005), however despite normal basal contractility at rest, there was no further augmentation with exercise. Mid and apical RVLSS increased with exercise suggestive of RV contractile reserve. In patients with resting RVSP < 35 mmHg, global and segmental RVLSS increased with exercise. In patients with resting RVSP ≥35 mmHg, global and segmental RVLSS did not increase with exercise and there was evidence of exertional RV dilation. CONCLUSION: Exercise provocation in conjunction with RVLSS identified differential regional contractile response to exercise in SSc patients. We further demonstrate the effect of increased loading conditions on RV contractile response exercise. These findings suggest subclinical impairments in RV reserve in SSc that may be missed by resting noninvasive 2DE-based assessments alone. |
| Databáze: | OpenAIRE |
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