Guo Di-Chen, Li Yi-Dan, Yang Yuan-Hua, Zhu Wei-Wei, Sun Lan-Lan, Jiang Wei, Ye Xiao-Guang, Cai Qi-Zhe, Lu Xiu-Zhang
Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Respiratory, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Echocardiography. 2019 Apr;36(4):671-677. doi: 10.1111/echo.14283. Epub 2019 Feb 22.
Right ventricular (RV) contractile reserve reflects the ability of RV to accommodate the increased afterload and may play an essential role in the evaluation of precapillary pulmonary hypertension (PH). This study aimed to assess RV contractile reserve based on exercise stress echocardiography (ESE) and to determine the echocardiographic determinants of exercise capacity in patients with precapillary PH.
A total of 31 patients with precapillary PH and 15 age- and sex-matched healthy control subjects were prospectively recruited. All subjects underwent ESE to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. Patients with precapillary PH also underwent cardiopulmonary exercise test (CPET), and data pertaining to peak oxygen uptake (peak VO ) and minute ventilation/carbon dioxide production (VE/VCO ) were collected.
Right ventricular contractile reserve including change in tricuspid annular plane systolic excursion (∆TAPSE), change in RV fractional area change (∆RVFAC), and change in Doppler-derived tricuspid lateral annular peak systolic velocity (∆S') was significantly depressed in precapillary PH patients compared with control subjects (P < 0.05). Parameters of RV function and RV contractile reserve were markedly associated with maximal exercise capacity (P < 0.05). ∆RVFAC was an independent predictor of peak VO (r = 0.601, P < 0.05).
Assessment of RV contractile reserve facilitates identification of subclinical dysfunction and evaluation of clinical status and severity of precapillary PH. ESE as a noninvasive method may provide a comprehensive clinical assessment and facilitate therapeutic decision-making for these patients.
右心室（RV）收缩储备反映了右心室适应增加的后负荷的能力，可能在毛细血管前性肺动脉高压（PH）的评估中起重要作用。本研究旨在基于运动负荷超声心动图（ESE）评估右心室收缩储备，并确定毛细血管前性PH患者运动能力的超声心动图决定因素。
前瞻性招募了31例毛细血管前性PH患者和15名年龄及性别匹配的健康对照者。所有受试者均接受ESE以评估静息和运动高峰时的右心室功能。计算运动期间这些参数的变化以量化右心室收缩储备。毛细血管前性PH患者还接受了心肺运动试验（CPET），并收集了与峰值摄氧量（peak VO）和分钟通气量/二氧化碳产生量（VE/VCO）相关的数据。
与对照组相比，毛细血管前性PH患者的右心室收缩储备，包括三尖瓣环平面收缩期位移变化（∆TAPSE）、右心室面积变化分数变化（∆RVFAC）和多普勒衍生的三尖瓣侧环峰值收缩速度变化（∆S'）明显降低（P < 0.05）。右心室功能和右心室收缩储备参数与最大运动能力显著相关（P < 0.05）。∆RVFAC是peak VO的独立预测因子（r = 0.601，P < 0.05）。
评估右心室收缩储备有助于识别亚临床功能障碍，并评估毛细血管前性PH的临床状态和严重程度。ESE作为一种非侵入性方法可为这些患者提供全面的临床评估，并有助于治疗决策。
