Right ventricular-arterial coupling in chronic thromboembolic pulmonary hypertension patients during exercise

Abstract

While exercise capacity is reduced in all forms of pulmonary hypertension, only in idiopathic pulmonary arterial hypertension (iPAH) this is known to be related to right ventricular (RV) -arterial uncoupling. Here we compare RV-arterial coupling (RVAC) during exercise between patients with chronic thromboembolic pulmonary hypertension (CTEPH) and iPAH.We prospectively included 12 CTEPH and 12 iPAH patients who performed a submaximal invasive cardiopulmonary exercise test between January 2013 and January 2019. RV contractility, defined as end-systolic elestance (Ees), and RV afterload (Ea) were assessed both at rest and during exercise by using single beat pressure-volume loop analysis. RVAC was calculated as Ees/Ea.RV afterload and contractility were similar at rest in iPAH and CTEPH (figure 1). In both groups, Ea significantly increased during exercise, while RV contractility did not change. Resting RVAC was higher in iPAH than in CPTEH (1,6 (0,6) vs. 1,2 (0,3); p<0.01). Only iPAH patients showed further RV uncoupling during exercise.CTEPH patients have a worse RV phenotype at rest compared to iPAH patients. Both groups fail to increase contractility during exercise.Figure 1. Right ventricular afterload (Ea), end-systolic elestance (Ees) and right ventriculo-arterial coupling (Ees/Ea) at rest and during exercise in patients with iPAH and CTEPHFootnotesCite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA1436.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).