Abstract 14106: Assessment of Right Ventricular to Pulmonary Circulation Uncoupling at Peak Exercise in Heart Failure Patients by the Relationship Between Pulmonary Systolic Pressure vs Right Ventricular Longitudinal Strain
Background: Speckle tracking analysis is an emerging technique that can be useful to assess abnormalities in cardiac contractility before traditional echo parameters.
Purpose: To investigate whether right ventricular (RV) 2D speckle tracking analysis at peak exercise could stratify a heart failure reduced ejection fraction (HFrEF) population in different functional phenotypes, with particular emphasis on RV to pulmonary circulation relationship.
Methods: 36 HFrEF patients (mean age 69±12; male 69%; NYHA I-II-III-IV 19-17-25-5 %) underwent a maximal cardiopulmonary exercise testing evaluation (bike, incremental ramp protocol) combined with Echo-Doppler and off-line speckle tracking analysis. Study population was divided in two groups according to median value of 2D right ventricle longitudinal strain at peak exercise (Group A RVLG at peak < -16, 17 patients vs Group B ≥ -16, 19 patients). In all patients we performed traditional echo and 2D longitudinal speckle tracking analysis at rest and peak exercise.
Results: Despite similar left ventricle ejection fraction (Group A 36± 9% vs Group B 32±9%, p=ns) and global right ventricle longitudinal strain (RVLG) at rest (Group A -18.6±5.6% vs Group B -14.5±8.2%, p=ns), Group B patients showed a similar exercise performance (Peak VO2Group A 31.6±7.4 vs Group B 11.6±3.4 mlO2/Kg/min, p=ns) but more impaired ventilation (VE/VCO2 slope Group A 31.6±7.4 vs Group B 37.4±8.8, p<0.05), and a clear RV to PC uncoupling at peak exercise as assessed by the relationship between pulmonary systolic pressure vs RVLG (see figure below).
Conclusions: In HFrEF RV speckle tracking analysis at peak exercise seems a useful technique for unmasking RV to PC uncoupling and the unfavorable gas exchange and ventilatory phenotypes.
Author Disclosures: V. Donghi: None. F. Carbone: None. V. Labate: None. G. Generati: None. M. Pellegrino: None. E. Alfonzetti: None. F. Bandera: None. M. Guazzi: None.
- © 2015 by American Heart Association, Inc.