Cardiology department, National Heart and Lung Institute, Imperial College, Hammersmith Hospital, Du Cane Road, W12 OHS, London, UK.
Cardiology Department, CHU de Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France.
Eur Heart J Cardiovasc Imaging. 2018 Feb 1;19(2):185-192. doi: 10.1093/ehjci/jex002.
To assess whether resting right ventricular (RV) function assessed by Global RV longitudinal strain (RVLS) and RV fractional area change (FAC) is associated with exercise performance in pulmonary arterial hypertension (PAH) and in chronic thromboembolic pulmonary hypertension (CTEPH).
We prospectively recruited 46 consecutive patients with PAH and 42 patients with CTEPH who were referred for cardio-pulmonary exercise testing (CPET) and transthoracic echocardiography. Resting RV systolic function was assessed with RVLS and FAC. CPET parameters analyzed were percentage of predicted maximal oxygen consumption (VO2max) and the slope of ventilation against carbon dioxide production (VE/VCO2). Spearman correlation was performed between echocardiographic measurements and CPET measurements. In PAH, spearman correlation found an association between RVLS and VE/VCO2 (coefficient = 0.556, P < 0.001) and percentage predicted VO2max (coefficient = -0.393, P = 0.007), while FAC was associated with VE/VCO2 (coefficient = -0.481, P = 0.001) and percentage of predicted VO2max (coefficient = 0.356, P = 0.015). Conversely, in CTEPH, resting RV function was neither associated with percentage of predicted VO2max nor with VE/VCO2, whether assessed by RVLS or FAC.
In PAH, resting RV function as assessed by FAC or RVLS is associated with exercise performance and could therefore make a significant contribution to non-invasive assessment in PAH patients. This association is not found in CTEPH, suggesting a disconnection between resting RV function and exercise performance, with implications for the use of exercise measurements as a prognostic marker and clinical/research endpoint in CTEPH.
评估右心室（RV）整体纵向应变（RVLS）和 RV 分数面积变化（FAC）评估的静息 RV 功能是否与肺动脉高压（PAH）和慢性血栓栓塞性肺动脉高压（CTEPH）患者的运动表现相关。
我们前瞻性招募了 46 例连续的 PAH 患者和 42 例 CTEPH 患者，这些患者因心肺运动测试（CPET）和经胸超声心动图而被转诊。使用 RVLS 和 FAC 评估静息 RV 收缩功能。分析 CPET 参数包括最大摄氧量预测百分比（VO2max）和通气与二氧化碳产量的斜率（VE/VCO2）。在 PAH 中，Spearman 相关性分析发现 RVLS 与 VE/VCO2（系数=0.556，P<0.001）和预测 VO2max 百分比（系数=-0.393，P=0.007）之间存在相关性，而 FAC 与 VE/VCO2（系数=-0.481，P=0.001）和预测 VO2max 百分比（系数=0.356，P=0.015）之间存在相关性。相反，在 CTEPH 中，静息 RV 功能，无论是通过 RVLS 还是 FAC 评估，均与预测 VO2max 百分比或 VE/VCO2 均无相关性。
在 PAH 中，FAC 或 RVLS 评估的静息 RV 功能与运动表现相关，因此对 PAH 患者的非侵入性评估有重要意义。在 CTEPH 中未发现这种相关性，提示静息 RV 功能与运动表现之间存在脱节，这对将运动测量作为 CTEPH 的预后标志物和临床/研究终点的应用具有重要意义。
