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. 2016 Nov;9(11):e005115.
doi: 10.1161/CIRCIMAGING.116.005115.

Right Ventricular Dysfunction Impairs Effort Tolerance Independent of Left Ventricular Function Among Patients Undergoing Exercise Stress Myocardial Perfusion Imaging

Jiwon Kim  1 , Antonino Di Franco  1 , Tania Seoane  1 , Aparna Srinivasan  1 , Polydoros N Kampaktsis  1 , Alexi Geevarghese  1 , Samantha R Goldburg  1 , Saadat A Khan  1 , Massimiliano Szulc  1 , Mark B Ratcliffe  1 , Robert A Levine  1 , Ashley E Morgan  1 , Pooja Maddula  1 , Meenakshi Rozenstrauch  1 , Tara Shah  1 , Richard B Devereux  1 , Jonathan W Weinsaft  2
Affiliations

Right Ventricular Dysfunction Impairs Effort Tolerance Independent of Left Ventricular Function Among Patients Undergoing Exercise Stress Myocardial Perfusion Imaging

Jiwon Kim et al. Circ Cardiovasc Imaging. 2016 Nov.

Abstract

Background: Right ventricular (RV) and left ventricular (LV) function are closely linked due to a variety of factors, including common coronary blood supply. Altered LV perfusion holds the potential to affect the RV, but links between LV ischemia and RV performance, and independent impact of RV dysfunction on effort tolerance, are unknown.

Methods and results: The population comprised 2051 patients who underwent exercise stress myocardial perfusion imaging and echo (5.5±7.9 days), among whom 6% had echo-evidenced RV dysfunction. Global summed stress scores were ≈3-fold higher among patients with RV dysfunction, attributable to increments in inducible and fixed LV perfusion defects (all P≤0.001). Regional inferior and lateral wall ischemia was greater among patients with RV dysfunction (both P<0.01), without difference in corresponding anterior defects (P=0.13). In multivariable analysis, inducible inferior and lateral wall perfusion defects increased the likelihood of RV dysfunction (both P<0.05) independent of LV function, fixed perfusion defects, and pulmonary artery pressure. Patients with RV dysfunction demonstrated lesser effort tolerance whether measured by exercise duration (6.7±2.8 versus 7.9±2.9 minutes; P<0.001) or peak treadmill stage (2.6±0.9 versus 3.1±1.0; P<0.001), paralleling results among patients with LV dysfunction (7.0±2.9 versus 8.0±2.9; P<0.001|2.7±1.0 versus 3.1±1.0; P<0.001 respectively). Exercise time decreased stepwise in relation to both RV and LV dysfunction (P<0.001) and was associated with each parameter independent of age or medication regimen.

Conclusions: Among patients with known or suspected coronary artery disease, regional LV ischemia involving the inferior and lateral walls confers increased likelihood of RV dysfunction. RV dysfunction impairs exercise tolerance independent of LV dysfunction.

Keywords: echocardiography; exercise; exercise test; exercise tolerance; heart failure.

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Figures

Figure 1
Figure 1. LV Perfusion Territories
Bullseye plots illustrating regional LV perfusion territories (highlighted). Each category comprised five segments, such that the total myocardium subtended by each was equivalent.
Figure 2
Figure 2. Exercise Time in Relation to Ventricular Function
Exercise time (during Bruce treadmill protocol) among groups partitioned based on LV and RV systolic function (LV dysfunction p=0.034, RV dysfunction p=0.008, interaction p=0.38). As shown, exercise time decreased in relation to extent of systolic dysfunction, as evidenced by stepwise decrements between patients with normal biventricular function, isolated LV or RV dysfunction, and those with biventricular dysfunction.
See this image and copyright information in PMC

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References

    1. Anavekar NS, Skali H, Bourgoun M, Ghali JK, Kober L, Maggioni AP, McMurray JJ, Velazquez E, Califf R, Pfeffer MA, Solomon SD. Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study) Am J Cardiol. 2008;101:607–612. - PubMed
    1. Zornoff LA, Skali H, Pfeffer MA, St John Sutton M, Rouleau JL, Lamas GA, Plappert T, Rouleau JR, Moye LA, Lewis SJ, Braunwald E, Solomon SD Investigators S. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. J Am Coll Cardiol. 2002;39:1450–1455. - PubMed
    1. Gulati A, Ismail TF, Jabbour A, Alpendurada F, Guha K, Ismail NA, Raza S, Khwaja J, Brown TD, Morarji K, Liodakis E, Roughton M, Wage R, Pakrashi TC, Sharma R, Carpenter JP, Cook SA, Cowie MR, Assomull RG, Pennell DJ, Prasad SK. The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy. Circulation. 2013;128:1623–1633. - PubMed
    1. Pfisterer M, Emmenegger H, Muller-Brand J, Burkart F. Prevalence and extent of right ventricular dysfunction after myocardial infarction--relation to location and extent of infarction and left ventricular function. Int J Cardiol. 1990;28:325–332. - PubMed
    1. Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, Friedman J, Diamond GA. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation. 1998;97:535–543. - PubMed

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