Right ventricular afterload and myocardial oxygen demand during exercise in pulmonary hypertension
D. Chemla, Y. Papelier, S. Hoette, N. Creuze, V. Castelain, G. Simonneau, M. Humbert, P. Herve (Clamart, Le Plessis Robinson, France)
Source: Annual Congress 2011 - Physiology of human pulmonary hypertension
Session: Physiology of human pulmonary hypertension
Session type: Thematic Poster Session
Number: 2315
Disease area: Pulmonary vascular diseases
Abstract Background and aim: In pulmonary hypertension (PH), the increased afterload leads to an increase in right ventricular (RV) myocardial oxygen demand. The RV mean systolic ejection pressure (Pms) and the RV systolic pressure time integral (SPTI) have been proposed as valuable estimates of RV afterload and myocardial oxygen demand, respectively. Our study documented the correlates of Pms and SPTI in PH patients. Material and methods: Eleven PH patients (mean pulmonary artery pressure mPAP = 57±10 mmHg) were studied, namely 6 arterial PH and 5 chronic thromboembolic PH. They underwent high-fidelity right heart catheterization at rest and on mild exercise (cycling) while supine. The workload was increased stepwise up to 60W and three-to-six hemodynamic points were obtained. The Pms was calculated as the pulmonary artery pressure (PAP) averaged over the systolic duration, i.e., from end-diastole to dicrotic notch. The SPTI was the Pms times the systolic period product. Results: The full data set consisted of 46 hemodynamic points. The Pms ranged from 60 to 117 mmHg and was related to systolic PAP (sPAP, r² = 0.99), mPAP (r² = 0.97) and PA pulse pressure (r²=0.86) (each P < 0.05) but not to systolic duration. The Pms matched 80% sPAP (bias = 0±2 mmHg). The SPTI ranged from 15.7 to 32.3 mmHg.sec and was related to PA pulse pressure (r²=0.80), sPAP (r²=0.67), mPAP (r²=0.46) and systolic duration (r²=0.22) (each P < 0.05). Conclusion: In PH patients performing mild exercise, RV afterload (Pms) was related to the steady component of arterial load (mPAP, sPAP) while the RV myocardial oxygen demand (SPTI) was mainly related to the pulsatile component of arterial load (pulse PA pressure).
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D. Chemla, Y. Papelier, S. Hoette, N. Creuze, V. Castelain, G. Simonneau, M. Humbert, P. Herve (Clamart, Le Plessis Robinson, France). Right ventricular afterload and myocardial oxygen demand during exercise in pulmonary hypertension. Eur Respir J 2011; 38: Suppl. 55, 2315
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