Exercise cardiac MRI unmasks right ventricular dysfunction in acute hypoxia and chronic pulmonary arterial hypertension

American Journal of Physiology. Heart and Circulatory Physiology
Shareen JaijeeDeclan P O'Regan

Abstract

Coupling of right ventricular (RV) contractility to afterload is maintained at rest in the early stages of pulmonary arterial hypertension (PAH), but exercise may unmask depleted contractile reserves. We assessed whether elevated afterload reduces RV contractile reserve despite compensated resting function using noninvasive exercise imaging. Fourteen patients with PAH (mean age: 39.1 yr, 10 women and 4 men) and 34 healthy control subjects (mean ageL 35.6 yr, 17 women and 17 men) completed real-time cardiac magnetic resonance imaging during submaximal exercise breathing room air. Control subjects were then also exercised during acute normobaric hypoxia (fraction of inspired O2: 12%). RV contractile reserve was assessed by the effect of exercise on ejection fraction. In control subjects, the increase in RV ejection fraction on exercise was less during hypoxia ( P = 0.017), but the response of left ventricular ejection fraction to exercise did not change. Patients with PAH had an impaired RV reserve, with half demonstrating a fall in RV ejection fraction on exercise despite comparable resting function to controls (PAH: rest 53.6 ± 4.3% vs. exercise 51.4 ± 10.7%; controls: rest 57.1 ± 5.2% vs. exercise 69.6 ± 6.1%, P < 0.0001). In ...Continue Reading

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Citations

Nov 23, 2019·American Journal of Physiology. Heart and Circulatory Physiology·Khodr TelloManuel J Richter
Aug 9, 2020·American Journal of Physiology. Heart and Circulatory Physiology·B RuijsinkR Razavi
Sep 11, 2020·Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance·Thomas P CravenJohn P Greenwood
Dec 10, 2020·Journal of Magnetic Resonance Imaging : JMRI·Krishna S NayakJennifer Steeden
Mar 4, 2021·Journal of Magnetic Resonance Imaging : JMRI·Cory R TrankleW Gregory Hundley
Apr 16, 2021·European Respiratory Review : an Official Journal of the European Respiratory Society·Simon MalenfantSteeve Provencher

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