Key result
Exercise amplifies adverse right-left ventricular interactions most profoundly in CTEPH and less so in HFpEF.
Why the study?
The contribution of adverse ventricular interdependence remains undervalued in heart failure or pulmonary vascular disease, and little is known regarding its dynamic nature during exercise and respiration.
Does exercise amplify adverse ventricular interaction assessed by cardiac MRI in patients with HFpEF and CTEPH compared to healthy controls?
Observational (n=46)
Does exercise amplify adverse ventricular interaction assessed by cardiac MRI in patients with HFpEF and CTEPH compared to healthy controls?
p-value: p=<0.05
Exercise cardiac MRI reveals that adverse right-left ventricular interactions are amplified during exercise, particularly in CTEPH and to a lesser extent in HFpEF, correlating with RV function and pulmonary hemodynamics.
Exercise cardiac MRI may identify amplified ventricular interactions in CTEPH and HFpEF; leaves open clinical relevance pending prospective validation.
AIMS: The contribution of adverse ventricular interdependence remains undervalued in heart failure or pulmonary vascular disease, and not much is known about its dynamic nature during exercise and respiration. In this study, we evaluated ventricular interaction during exercise in patients with heart failure with preserved ejection fraction (HFpEF) and patients with chronic thromboembolic pulmonary hypertension (CTEPH) as compared with healthy controls. METHODS AND RESULTS: Forty-six subjects (10 controls, 19 CTEPH patients, and 17 HFpEF patients) underwent cardiac magnetic resonance imaging during exercise. Ventricular interaction was determined through analysis of the septal curvature (SC) of a mid-ventricular short-axis slice at end-diastole, end-systole, and early-diastole, both in expiration and inspiration. Exercise amplified ventricular interaction in CTEPH patients and to a lesser extent in HFpEF patients (P < 0.05 for decrease in SC with exercise). Adverse interaction was most profound in early-diastole and most pronounced in CTEPH patients (P < 0.05 interaction group * exercise) because of a disproportionate increase RV afterload (P < 0.05 to both controls and HFpEF) and diastolic pericardial restraint (P < 0.001 for interaction group * exercise) during exercise. Inspiration enhanced diastolic interdependence in CTEPH and HFpEF patients (P < 0.05 vs. expiration). Both at rest and during exercise, SC strongly correlated with RV volumes and pulmonary artery pressures (all P < 0.05). CONCLUSIONS: Exercise amplifies adverse right-left ventricular interactions in CTEPH, while a more moderate effect is observed in isolated post-capillary HFpEF. Given the strong link with RV function and pulmonary hemodynamic, assessing ventricular interaction with exCMR might be valuable from a diagnostic or therapeutic perspective.
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Claeys et al. (2022) conducted an observational in HFpEF and CTEPH (n=46). Exercise cardiac magnetic resonance imaging vs. Healthy controls was evaluated on Ventricular interaction determined through analysis of the septal curvature (SC) (p=<0.05). Exercise amplified adverse right-left ventricular interactions, measured by septal curvature, most profoundly in CTEPH patients and to a lesser extent in HFpEF patients (P < 0.05).
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