Assessment of right ventricular reserve utilizing exercise provocation in systemic sclerosis.
Echocardiography
Exercise stress
Longitudinal strain
Pulmonary hypertension
Right ventricle
Systemic sclerosis
Journal
The international journal of cardiovascular imaging
ISSN: 1875-8312
Titre abrégé: Int J Cardiovasc Imaging
Pays: United States
ID NLM: 100969716
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
30
01
2021
accepted:
03
04
2021
pubmed:
17
4
2021
medline:
16
10
2021
entrez:
16
4
2021
Statut:
ppublish
Résumé
Right ventricular (RV) capacity to adapt to increased afterload is the main determinant of outcome in pulmonary hypertension, 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. 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. 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. 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.
Identifiants
pubmed: 33860914
doi: 10.1007/s10554-021-02237-9
pii: 10.1007/s10554-021-02237-9
pmc: PMC8292174
mid: NIHMS1695335
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2137-2147Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL114910
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL146889
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23-HL146889
Pays : United States
Organisme : NIAMS NIH HHS
ID : R01AR073208
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01-HL114910
Pays : United States
Organisme : NIAMS NIH HHS
ID : R01 AR073208
Pays : United States
Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Nature B.V.
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