Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Department of Cardiovascular Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Am J Physiol Heart Circ Physiol. 2023 Mar 1;324(3):H355-H363. doi: 10.1152/ajpheart.00626.2022. Epub 2023 Jan 27.
Although measuring right ventricular (RV) function during exercise is more informative than assessing it at rest, the relationship between RV reserve function, exercise capacity, and health-related quality of life (HRQoL) in patients with left ventricular assist devices (LVAD) remains unresolved. We aimed to investigate whether RV reserve assessed by the change in RV stroke work index (RVSWI) during exercise is correlated with exercise capacity and HRQoL in patients with LVAD. We prospectively assessed 24 consecutive patients with LVAD who underwent invasive right heart catheterization in the supine position. Exercise capacity and HRQoL were assessed using the 6-min walk distance (6 MWD) and peak oxygen consumption (V̇o) in cardiopulmonary exercise testing, and the EuroQol visual analog scale (EQ-VAS), respectively. The patients were divided into two groups according to the median ΔRVSWI (change from rest to peak exercise). Patients with lower ΔRVSWI had significantly lower changes in cardiac index and absolute value of RV dP/d than those with higher ΔRVSWI. The ΔRVSWI was positively correlated with 6 MWD ( = 0.59, = 0.003) and peak V̇o ( = 0.56, = 0.006). In addition, ΔRVSWI was positively correlated with the EQ-VAS ( = 0.44, = 0.030). In contrast, there was no significant correlation between RVSWI at rest and 6 MWD ( = -0.34, = 0.88), peak V̇o ( = 0.074, = 0.74), or EQ-VAS ( = 0.127, = 0.56). Our findings suggest that the assessment of RV reserve function is useful for risk stratification in patients with LVAD. The change in right ventricular stroke work index (RVSWI) during exercise, not RVSWI at rest, was associated with exercise capacity and HRQoL. Our findings suggest that the assessment of change in RVSWI during exercise as a surrogate of RV reserve function may aid in risk stratification of patients with LVAD.
虽然在运动过程中测量右心室（RV）功能比在休息时更有意义，但左心室辅助装置（LVAD）患者的 RV 储备功能、运动能力和健康相关生活质量（HRQoL）之间的关系仍未得到解决。我们旨在研究在 LVAD 患者中，通过运动时 RV 每搏功指数（RVSWI）的变化评估 RV 储备功能是否与运动能力和 HRQoL 相关。我们前瞻性评估了 24 例连续接受 LVAD 治疗并在仰卧位接受有创右心导管检查的患者。运动能力和 HRQoL 通过心肺运动试验中的 6 分钟步行距离（6MWD）和峰值摄氧量（V̇o）以及 EuroQol 视觉模拟量表（EQ-VAS）分别进行评估。根据 RVSWI 的中位数（从休息到峰值运动的变化）将患者分为两组。ΔRVSWI 较低的患者的心脏指数和 RV dp/dt 绝对值的变化明显低于ΔRVSWI 较高的患者。ΔRVSWI 与 6MWD 呈正相关（ = 0.59， = 0.003），与峰值 V̇o 呈正相关（ = 0.56， = 0.006）。此外，ΔRVSWI 与 EQ-VAS 呈正相关（ = 0.44， = 0.030）。相反，RVSWI 在休息时与 6MWD 之间无显著相关性（ = -0.34， = 0.88），与峰值 V̇o 之间无显著相关性（ = 0.074， = 0.74），与 EQ-VAS 之间无显著相关性（ = 0.127， = 0.56）。我们的研究结果表明，评估 RV 储备功能对于 LVAD 患者的风险分层是有用的。运动时 RV 每搏功指数（RVSWI）的变化，而不是静息时的 RVSWI，与运动能力和 HRQoL 相关。我们的研究结果表明，评估运动时 RVSWI 的变化作为 RV 储备功能的替代指标可能有助于 LVAD 患者的风险分层。
