Abstract 13304: Prevalence, Perfusion-Based Markers, and Exercise Manifestations of Right Ventricular Dysfunction Among 2,051 Consecutive Patients Undergoing Exercise Myocardial Perfusion Imaging
Introduction: Right (RV) and left ventricular (LV) performance are linked via common coronary supply: Impact of altered LV perfusion on the RV, and independent influence of RV dysfunction (RVdys) on effort tolerance are unknown.
Methods: The population comprised pts undergoing myocardial perfusion imaging (MPI) and echocardiography (echo) within 1 month (5.5±7.9 days): RVdys was defined via standard echo criteria (TAPSE < 1.6 cm, RV S’ < 10mm/s). MPI was the reference for LV ischemia; effort tolerance was assessed via exercise treadmill testing (ETT) at time of MPI.
Results: 2051 pts (64±12 yo, 59%M) were studied; 6% had RVdys on echo. Pts with RVdys had lower LVEF (53±14 vs. 62±9%), larger LV size (55±23 vs. 48±16 ml/m2) and higher PA systolic pressure (34±12 vs 30±7 mmHg; all p<0.01). On MPI, summed stress score was 3 fold higher among pts with RVdys (6.9±8.5 v. 2.7±6.1, p<0.001). LV inferior (0.7±1.7 v. 0.2±1.0, p=0.007) and lateral ischemic defects (1.2±2.6 v. 0.2±1.1, p<0.001) were larger in pts with RVdys (both p<0.01); but anterior defects did not differ (p=NS): Inducible inferior and lateral perfusion defects increased likelihood for RVdys (both p<0.001) independent of LV function and PA pressure. Pts with RVdys had lesser heart rate (α 56±26 vs. 69±24 bpm) and blood pressure augmentation (α 28±31 vs. 41±27mmHg, both p<0.001) during ETT, paralleling lower effort duration (6.7±2.8 vs. 7.9±2.9 min, p<0.001): Effort duration decreased in relation to both LV and RVdys, as evidenced by stepwise decrements among pts with normal biventricular function, isolated LV or RVdys and pts with biventricular dysfunction [Figure]: Impaired effort tolerance was independently associated with RVdys (regression coefficient 0.73 [CI 0.14-1.31], p=0.02) and LVdys (0.71 [0.27-1.16], p=0.002), even after controlling for age and β blocker use.
Conclusions: LV ischemia in inferior and lateral walls confers increased likelihood for RVdys. RVdys impairs exercise tolerance independent of LVdys.
Author Disclosures: A. Di Franco: None. J.W. Weinsaft: None. T. Seoane: None. A. Srinivasan: None. P.N. Kampaktsis: None. A. Geevarghese: None. M. Rozenstrauch: None. S.A. Khan: None. M. Szulc: None. M.B. Ratcliffe: None. R.A. Levine: None. A.E. Morgan: None. T. Shah: None. R.B. Devereux: None. J. Kim: None.
- © 2016 by American Heart Association, Inc.