Key result
Patients with pulmonary arterial hypertension and enlarged right ventricular area (>20 cm2) had a significantly lower increase in cardiac index during exercise compared to those with smaller right ventricular size (1.7 vs 2.73 L/min/m2, p=0.002).
Cross-Sectional (n=54)
No
Absolute Event Rate: 1.7% vs 2.73%
p-value: p=0.002
In patients with pulmonary arterial hypertension, right ventricular and right atrial areas measured by echocardiography are significant indicators of right ventricular pump function and output reserve during exercise.
The objective of this study was to assess, whether right atrial (RA) and ventricular (RV) size is related to RV pump function at rest and during exercise in patients with pulmonary arterial hypertension (PAH). We included 54 patients with invasively diagnosed PAH that had been stable on targeted medication. All patients underwent clinical assessments including right heart catheterization and echocardiography at rest and during exercise. RV output reserve was defined as increase of cardiac index (CI) from rest to peak exercise (∆CI exercise ). Patients were classified according to the median of RA and RV-area. RV pump function and further clinical parameters were compared between groups by student’s t-test. Uni- and multivariate Pearson correlation analyses were performed. Patients with larger RA and/or RV-areas (above a median of 16 and 20cm 2 , respectively) showed significantly lower ∆CI exercise , higher mean pulmonary arterial pressure, pulmonary vascular resistance at rest and NT-proBNP levels. Furthermore, patients with higher RV-areas presented with a significantly lower RV stroke volume and pulmonary arterial compliance at peak exercise than patients with smaller RV-size. RV area was identified as the only independent predictor of RV output reserve. RV and RA areas represent valuable and easily accessible indicators of RV pump function at rest and during exercise. Cardiac output reserve should be considered as an important clinical parameter. Prospective studies are needed for further evaluation.
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Fischer et al. (2018) conducted a cross-sectional in Pulmonary arterial hypertension (n=54). Enlarged right ventricular area (>20 cm2) vs. Normal/smaller right ventricular area (≤20 cm2) was evaluated on Increase of cardiac index from rest to peak exercise (ΔCIexercise) (p=0.002). Patients with pulmonary arterial hypertension and enlarged right ventricular area (>20 cm2) had a significantly lower increase in cardiac index during exercise compared to those with smaller right ventricular size (1.7 vs 2.73 L/min/m2, p=0.002).
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