High Right Ventricular Afterload during Exercise in Patients with Pulmonary Arterial Hypertension

Nishizaki, Mari; Ogawa, Aiko; Matsubara, Hiromi

doi:10.3390/jcm10092024

Cited by 4 publications

(4 citation statements)

References 57 publications

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“…The RV response to exercise abnormally in most patients with pulmonary arterial hypertension. Moreover, the increased RV afterload during exercise increases the RV wall stress, leading to long-term clinical deterioration [43]. Therefore, an ET program should be used with caution in patients with severe RV dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Effects of a Long-Term Wearable Activity Tracker-Based Exercise Intervention on Cardiac Morphology and Function of Patients with Cystic Fibrosis

Anifanti

Giannakoulakos

Hatziagorou

et al. 2022

Sensors

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Several studies have shown that patients with cystic fibrosis (CF), even at a young age, have pulmonary and cardiac abnormalities. The main complications are cardiac right ventricular (RV) systolic and/or diastolic dysfunction and pulmonary hypertension, which affects their prognosis. Exercise training (ET) is recommended in patients with CF as a therapeutic modality to improve physical fitness and health-related quality of life. However, questions remain regarding its optimal effective and safe dose and its effects on the patients’ cardiac function. The study aimed to provide a wearable activity tracker (WAT)-based ET to promote physical activity in CF patients and assess its effects on cardiac morphology and function. Forty-two stable CF individuals (aged 16.8 ± 3.6 years) were randomly assigned to either the intervention (Group A) or the control group (Group B). Group A participated in a 1-year WAT-based ET program three times per week. All patients underwent a 6-min walking test (6-MWT) and an echocardiographic assessment focused mainly on RV anatomy and function at the baseline and the end of the study. RV systolic function was evaluated by measuring the tricuspid annular plane systolic excursion (TAPSE), the systolic tricuspid annular velocity (TVS’), the RV free-wall longitudinal strain (RVFWSL), and the right ventricular four-chamber longitudinal strain (RV4CSL). RV diastolic function was assessed using early (TVE) and late (TVA) diastolic transtricuspid flow velocity and their ratio TVE/A. Pulmonary artery systolic pressure (PASP) was also estimated. In Group A after ET, the 6MWT distance improved by 20.6% (p < 0.05), TVA decreased by 17% (p < 0.05), and TVE/A increased by 13.2% (p < 0.05). Moreover, TAPSE, TVS’, RVFWSL, and RV4CSL increased by 8.3% (p < 0.05), 9.0% (p < 0.05), 13.7% (p < 0.05), and 26.7% (p < 0.05), respectively, while PASP decreased by 7.6% (p < 0.05). At the end of the study, there was a significant linear correlation between the number of steps and the PASP (r = −0.727, p < 0.01) as well as the indices of RV systolic function in Group A. In conclusion, WAT is a valuable tool for implementing an effective ET program in CF. Furthermore, ET has a positive effect on RV systolic and diastolic function.

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Section: Discussionmentioning

confidence: 99%

Effects of a Long-Term Wearable Activity Tracker-Based Exercise Intervention on Cardiac Morphology and Function of Patients with Cystic Fibrosis

Anifanti

Giannakoulakos

Hatziagorou

et al. 2022

Sensors

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show abstract

“…The optimal approach to exercise training in PH to achieve benefit without the detriment of maladaptive RV remodeling is unknown. 107 Hitting an exercise benefit threshold without being detrimental is important to understand and then translate into exercise prescriptions. For example, high‐intensity interval training (HIIT) for rat models with mild PH reversed RV hypertrophy but not with continuous training and it is unclear how this translates to different disease severity and etiology.…”

Section: Beyond Vasodilators‐nonmedical Interventions For Ph: Role Of...mentioning

confidence: 99%

“…The optimal approach to exercise training in PH to achieve benefit without the detriment of maladaptive RV remodeling is unknown 107 . Hitting an exercise benefit threshold without being detrimental is important to understand and then translate into exercise prescriptions.…”

Section: Beyond Vasodilators‐nonmedical Interventions For Ph: Role Of...mentioning

confidence: 99%

Pulmonary Hypertension Association's 2022 International Conference Scientific Sessions Overview

et al. 2023

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The considerable progress made in recent years in the diagnosis, risk stratification, and treatment of pulmonary hypertension was highlighted during the most recent edition of the Pulmonary Hypertension Association Scientific Sessions, which was held in Atlanta, Georgia from June 9 to 11, 2022, with the theme: Vision for the PHuture: The Evolving Science and Management of PH. Content presented over the 3‐day conference focused on scientific and management updates since the last sessions were held in 2018 and included didactic talks, debates, and roundtable discussions across a broad spectrum of topics related to pulmonary hypertension. This article aims to summarize the key messages from each of the session talks.

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“…Previous studies on this topic show that although there are parallels in left and right ventricular adaptation to volume and pressure changes, there are also relevant differences 7 , 8 . The fast response to load or Frank-Starling mechanism (FSM) appears to play a role in the RV 9 – 11 , where an increase in ventricular filling leads to an increase in the work done between consecutive beats.…”

Section: Introductionmentioning

confidence: 99%

Intrinsic mechanisms of right ventricular autoregulation

Meinert-Krause,

Mechelinck,

Hein

et al. 2024

Sci Rep

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To elucidate the adaptation of the right ventricle to acute and intermittently sustained afterload elevation, targeted preload reductions and afterload increases were implemented in a porcine model involving 12 pigs. Preload reduction was achieved via balloon occlusion of the inferior vena cava before, immediately and 5 min after acute afterload elevation induced by pulmonary artery occlusion or thromboxane A2 analog (U46619) infusion. Ventricular response was monitored by registration of pressure–volume (PV) loops using a conductance catheter. The end-systolic pressure–volume relationship (ESPVR) during pure preload reduction was adequately described by linear regression (mean and SEM slope of ESPVR (Ees) 0.414 ± 0.064 mmHg/ml), reflecting the classical Frank-Starling mechanism (FSM). The ESPVR during acute afterload elevation exhibited a biphasic trajectory with significantly distinct slopes (mean and SEM Ees bilin1: 1.256 ± 0.066 mmHg ml; Ees bilin2: 0.733 ± 0.063 mmHg ml, p < 0.001). The higher slope during the first phase in the absence of ventricular dilation could be explained by a reduced amount of shortening deactivation (SDA). The changes in PV-loops during the second phase were similar to those observed with a preload intervention. The persistent increase in afterload resulted in an increase in the slopes of ESPVR and preload recruitable stroke work (PRSW) with a slight decrease in filling state, indicating a relevant Anrep effect. This effect became more pronounced after 5 min or TXA infusion. This study demonstrates, for the first time, the relevance of intrinsic mechanisms of cardiac autoregulation in the right ventricle during the adaptation to load. The SDA, FSM, and Anrep effect could be differentiated and occurred successively, potentially with some overlap. Notably, the Anrep effect serves to prevent ventricular dilation.

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High Right Ventricular Afterload during Exercise in Patients with Pulmonary Arterial Hypertension

Cited by 4 publications

References 57 publications

Effects of a Long-Term Wearable Activity Tracker-Based Exercise Intervention on Cardiac Morphology and Function of Patients with Cystic Fibrosis

Effects of a Long-Term Wearable Activity Tracker-Based Exercise Intervention on Cardiac Morphology and Function of Patients with Cystic Fibrosis

Pulmonary Hypertension Association's 2022 International Conference Scientific Sessions Overview

Intrinsic mechanisms of right ventricular autoregulation

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