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Eur Respir J. 2019 Nov 21;54(5). pii: 1900342. doi: 10.1183/13993003.00342-2019. Print 2019 Nov.

Impaired right ventricular lusitropy is associated with ventilatory inefficiency in pulmonary arterial hypertension.

Author information

1
Dept of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany Khodr.Tello@innere.med.uni-giessen.de.
2
Dept of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.
3
University of Arizona, Tucson, AZ, USA.
4
Dept of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.
5
Dept of Medicine, Imperial College London, London, UK.
6
Erasme University Hospital, Brussels, Belgium.
7
Dept of Radiology, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.
8
Dept of Cardiology, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.

Abstract

Cardiopulmonary exercise testing (CPET) is an important tool for assessing functional capacity and prognosis in pulmonary arterial hypertension (PAH). However, the associations of CPET parameters with the adaptation of right ventricular (RV) function to afterload remain incompletely understood.In this study, 37 patients with PAH (idiopathic in 31 cases) underwent single-beat pressure-volume loop measurements of RV end-systolic elastance (Ees), arterial elastance (Ea) and diastolic elastance (Eed). Pulmonary arterial stiffness was assessed by magnetic resonance imaging. The results were correlated to CPET variables. The predictive relevance of RV function parameters for clinically relevant ventilatory inefficiency, defined as minute ventilation/carbon dioxide production (V' E/V' CO2 ) slope >48, was evaluated using logistic regression analysis.The median (interquartile range) of the V' E/V' CO2 slope was 42 (32-52) and the V' E/V' CO2 nadir was 40 (31-44). The mean±sd of peak end-tidal carbon dioxide tension (P ETCO2 ) was 23±8 mmHg. Ea, Eed and parameters reflecting pulmonary arterial stiffness (capacitance and distensibility) correlated with the V' E/V' CO2 slope, V' E/V' CO2 nadir, P ETCO2 and peak oxygen pulse. RV Ees and RV-arterial coupling as assessed by the Ees/Ea ratio showed no correlations with CPET parameters. Ea (univariate OR 7.28, 95% CI 1.20-44.04) and Eed (univariate OR 2.21, 95% CI 0.93-5.26) were significantly associated with ventilatory inefficiency (p<0.10).Our data suggest that impaired RV lusitropy and increased afterload are associated with ventilatory inefficiency in PAH.

Conflict of interest statement

Conflict of interest: K. Tello reports that this work was funded by the Excellence Cluster Cardio-Pulmonary System (ECCPS) and the Collaborative Research Center (SFB) 1213 - Pulmonary Hypertension and Cor Pulmonale, grant number SFB1213/1, project B08 (grant from German Research Foundation, Bonn, Germany) and editorial support was funded by University of Giessen, during the conduct of the study; and personal fees for lectures from Actelion and Bayer, outside the submitted work. Conflict of interest: A. Dalmer has nothing to disclose. Conflict of interest: R. Vanderpool has nothing to disclose. Conflict of interest: H.A. Ghofrani reports that this work was funded by the ECCPS and the Collaborative Research Center (SFB) 1213 - Pulmonary Hypertension and Cor Pulmonale, grant number SFB1213/1, project B08 (grant from German Research Foundation, Bonn, Germany) and editorial support was funded by University of Giessen, during the conduct of the study; and personal fees for consultancy and advisory board work from Bayer and Pfizer, personal fees for consultancy, lectures and advisory board work from Actelion and GSK, personal fees for consultancy from Merck, grants and personal fees for consultancy from Novartis, grants and personal fees for lectures from Bayer HealthCare and Encysive/Pfizer, grants from Aires, German Research Foundation, Excellence Cluster Cardiopulmonary Research and German Ministry for Education and Research, and personal fees for advisory board work from Takeda, outside the submitted work. Conflict of interest: R. Naeije reports grants and personal fees for consultancy and advisory board work from AOP Orphan Pharmaceuticals, Actelion, Bayer, Reata, Lung Biotechnology Corporation and United Therapeutics, outside the submitted work. Conflict of interest: F. Roller has nothing to disclose. Conflict of interest: W. Seeger reports that this work was funded by the ECCPS and the Collaborative Research Center (SFB) 1213 - Pulmonary Hypertension and Cor Pulmonale, grant number SFB1213/1, project B08 (grant from German Research Foundation, Bonn, Germany) and editorial support was funded by University of Giessen, during the conduct of the study; and personal fees for consultancy and lectures from Pfizer and Bayer Pharma AG, outside the submitted work. Conflict of interest: D. Dumitrescu reports personal fees and advisory board membership from Actelion and Novartis, and personal fees from Bayer Healthcare, GSK, MSD and Servier, outside the submitted work. Conflict of interest: N. Sommer reports personal fees from Actelion, outside the submitted work. Conflict of interest: A. Brunst has nothing to disclose. Conflict of interest: H. Gall reports that this work was funded by the ECCPS and the Collaborative Research Center (SFB) 1213 - Pulmonary Hypertension and Cor Pulmonale, grant number SFB1213/1, project B08 (grant from German Research Foundation, Bonn, Germany) and editorial support was funded by University of Giessen, during the conduct of the study; and personal fees from Actelion, AstraZeneca, Bayer, BMS, GSK, Janssen-Cilag, Lilly, MSD, Novartis, OMT, Pfizer and United Therapeutics, outside the submitted work. Conflict of interest: M.J. Richter reports that this work was funded by the ECCPS and the Collaborative Research Center (SFB) 1213 - Pulmonary Hypertension and Cor Pulmonale, grant number SFB1213/1, project B08 (grant from German Research Foundation, Bonn, Germany) and editorial support was funded by University of Giessen, during the conduct of the study; and grants from United Therapeutics, grants and personal fees for consultancy and lectures from Bayer, and personal fees for lectures from Actelion, Mundipharma, Roche and OMT, outside the submitted work.

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