Alessandro Bellofiore1, Eric Dinges2, Robert Naeije3, Hamorabi Mkrdichian4, Lauren Beussink-Nelson4, Melissa Bailey5, Michael J Cuttica6, Ranya Sweis4, James R Runo7, Jon G Keevil8, Christopher J Francois9, Sanjiv J Shah4,6, Naomi C Chesler2,5. 1. Department of Biomedical, Chemical and Materials Engineering, San Jose State University, San Jose, California, USA. 2. Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA. 3. Department of Cardiology, Erasme University Hospital, Brussels, Belgium. 4. Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. 5. Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA. 6. Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, Illinois, USA. 7. Division of Pulmonary and Critical Care Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA. 8. Department of Cardiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA. 9. Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Abstract
OBJECTIVE: Inadequate right ventricular (RV) and pulmonary arterial (PA) functional responses to exercise are important yet poorly understood features of pulmonary arterial hypertension (PAH). This study combined invasive catheterisation with echocardiography to assess RV afterload, RV function and ventricular-vascular coupling in subjects with PAH. METHODS: Twenty-six subjects with PAH were prospectively recruited to undergo right heart catheterisation and Doppler echocardiography at rest and during incremental exercise, and cardiac MRI at rest. Measurements at rest included basic haemodynamics, RV function and coupling efficiency (η). Measurements during incremental exercise included pulmonary vascular resistance (Z0), characteristic impedance (ZC, a measure of proximal PA stiffness) and proximal and distal PA compliance (CPA). RESULTS: In patients with PAH, the proximal PAs were significantly stiffer at maximum exercise (ZC =2.31±0.38 vs 1.33±0.15 WU×m2 at rest; p=0.003) and PA compliance was decreased (CPA=0.88±0.10 vs 1.32±0.17 mL/mm Hg/m2 at rest; p=0.0002). Z0 did not change with exercise. As a result, the resistance-compliance (RC) time decreased with exercise (0.67±0.05 vs 1.00±0.07 s at rest; p<10-6). When patients were grouped according to resting coupling efficiency, those with poorer η exhibited stiffer proximal PAs at rest, a lower maximum exercise level, and more limited CPA reduction at maximum exercise. CONCLUSIONS: In PAH, exercise causes proximal and distal PA stiffening, which combined with preserved Z0 results in decreased RC time with exercise. Stiff PAs at rest may also contribute to poor haemodynamic coupling, reflecting reduced pulmonary vascular reserve that contributes to limit the maximum exercise level tolerated. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: Inadequate right ventricular (RV) and pulmonary arterial (PA) functional responses to exercise are important yet poorly understood features of pulmonary arterial hypertension (PAH). This study combined invasive catheterisation with echocardiography to assess RV afterload, RV function and ventricular-vascular coupling in subjects with PAH. METHODS: Twenty-six subjects with PAH were prospectively recruited to undergo right heart catheterisation and Doppler echocardiography at rest and during incremental exercise, and cardiac MRI at rest. Measurements at rest included basic haemodynamics, RV function and coupling efficiency (η). Measurements during incremental exercise included pulmonary vascular resistance (Z0), characteristic impedance (ZC, a measure of proximal PA stiffness) and proximal and distal PA compliance (CPA). RESULTS: In patients with PAH, the proximal PAs were significantly stiffer at maximum exercise (ZC =2.31±0.38 vs 1.33±0.15 WU×m2 at rest; p=0.003) and PA compliance was decreased (CPA=0.88±0.10 vs 1.32±0.17 mL/mm Hg/m2 at rest; p=0.0002). Z0 did not change with exercise. As a result, the resistance-compliance (RC) time decreased with exercise (0.67±0.05 vs 1.00±0.07 s at rest; p<10-6). When patients were grouped according to resting coupling efficiency, those with poorer η exhibited stiffer proximal PAs at rest, a lower maximum exercise level, and more limited CPA reduction at maximum exercise. CONCLUSIONS: In PAH, exercise causes proximal and distal PA stiffening, which combined with preserved Z0 results in decreased RC time with exercise. Stiff PAs at rest may also contribute to poor haemodynamic coupling, reflecting reduced pulmonary vascular reserve that contributes to limit the maximum exercise level tolerated. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Robert V MacKenzie Ross; Mark R Toshner; Elaine Soon; Robert Naeije; Joanna Pepke-Zaba Journal: Am J Physiol Heart Circ Physiol Date: 2013-05-17 Impact factor: 4.733
Authors: Ryan J Tedford; Paul M Hassoun; Stephen C Mathai; Reda E Girgis; Stuart D Russell; David R Thiemann; Oscar H Cingolani; James O Mudd; Barry A Borlaug; Margaret M Redfield; David J Lederer; David A Kass Journal: Circulation Date: 2011-11-30 Impact factor: 29.690
Authors: Rebecca R Vanderpool; Michael R Pinsky; Robert Naeije; Christopher Deible; Vijaya Kosaraju; Cheryl Bunner; Michael A Mathier; Joan Lacomis; Hunter C Champion; Marc A Simon Journal: Heart Date: 2014-09-11 Impact factor: 5.994
Authors: Guido Claessen; Andre La Gerche; Steven Dymarkowski; Piet Claus; Marion Delcroix; Hein Heidbuchel Journal: J Am Heart Assoc Date: 2015-03-23 Impact factor: 5.501
Authors: Farhan Raza; Callyn Kozitza; Chris Lechuga; Daniel Seiter; Philip Corrado; Mohammed Merchant; Naga Dharmavaram; Claudia Korcarz; Marlowe Eldridge; Christopher Francois; Oliver Wieben; Naomi Chesler Journal: Function (Oxf) Date: 2022-04-30
Authors: David G Kiely; David Levin; Paul Hassoun; David D Ivy; Pei-Ni Jone; Jumaa Bwika; Steven M Kawut; Jim Lordan; Angela Lungu; Jeremy Mazurek; Shahin Moledina; Horst Olschewski; Andrew Peacock; Goverdhan Dutt Puri; Farbod Rahaghi; Michal Schafer; Mark Schiebler; Nicholas Screaton; Merryn Tawhai; Edwin Jr Van Beek; Anton Vonk-Noordegraaf; Rebecca R Vanderpool; John Wort; Lan Zhao; Jim Wild; Jens Vogel-Claussen; Andrew J Swift Journal: Pulm Circ Date: 2019-03-18 Impact factor: 3.017
Authors: Blanca Trejo-Velasco; Óscar Fabregat-Andrés; Pilar M García-González; Diana C Perdomo-Londoño; Andrés M Cubillos-Arango; Mónica I Ferrando-Beltrán; Joaquina Belchi-Navarro; José L Pérez-Boscá; Rafael Payá-Serrano; Francisco Ridocci-Soriano Journal: J Cardiovasc Magn Reson Date: 2020-04-30 Impact factor: 5.364