RT Journal Article
SR Electronic
T1 Impaired right ventricular lusitropy is associated with ventilatory inefficiency in PAH
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1900342
DO 10.1183/13993003.00342-2019
A1 Khodr Tello
A1 Antonia Dalmer
A1 Rebecca Vanderpool
A1 Hossein A. Ghofrani
A1 Robert Naeije
A1 Fritz Roller
A1 Werner Seeger
A1 Daniel Dumitrescu
A1 Natascha Sommer
A1 Anne Brunst
A1 Henning Gall
A1 Manuel J. Richter
YR 2019
UL http://erj.ersjournals.com/content/early/2019/08/21/13993003.00342-2019.abstract
AB Cardiopulmonary exercise testing (CPET) is an important tool to assess functional capacity and prognosis in pulmonary arterial hypertension (PAH). However, the association of CPET parameters with the adaptation of right ventricular (RV) function to afterload remains incompletely understood.Thirty-seven 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). They also underwent magnetic resonance imaging of pulmonary arterial stiffness. The results were correlated to CPET variables. Predictive relevance of RV function parameters for clinically relevant ventilatory inefficiency, defined as minute ventilation/carbon dioxide production (VE/VCO2) slope >48, was evaluated using logistic regression analysis.Median [interquartile range] of VE/VCO2 slope was 42 [32–52], of VE/VCO2 nadir was 40 [31–44], and mean±sd of peak end-tidal CO2 tension (PETCO2) was 23±8 mmHg. Ea, Eed and parameters reflecting pulmonary arterial stiffness (capacitance and distensibility) were correlated to VE/VCO2 slope, VE/VCO2 nadir, PETCO2 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 odds ratio: 7.28; 95% confidence interval: 1.20–44.04) and Eed (univariate odds ratio: 2.21; 95% confidence interval: 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.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Tello reports grants from German Research Foundation, non-financial support from University of Giessen, during the conduct of the study; personal fees from Actelion, personal fees from Bayer, outside the submitted work.Conflict of interest: Dr. Dalmer has nothing to disclose.Conflict of interest: Dr. Vanderpool has nothing to disclose.Conflict of interest: Dr. Ghofrani reports grants from German Research Foundation, non-financial support from University of Giessen, during the conduct of the study; personal fees from Bayer, personal fees from Actelion, personal fees from Pfizer, personal fees from Merck, personal fees from GSK, grants and personal fees from Novartis, grants and personal fees from Bayer HealthCare, grants and personal fees from Encysive/Pfizer, grants from Aires, grants from German Research Foundation, grants from Excellence Cluster Cardiopulmonary Research, grants from German Ministry for Education and Research, personal fees from Takeda, outside the submitted work.Conflict of interest: Dr. Naeije reports grants and personal fees from AOPOrphan Pharmaceuticals, grants and personal fees from Actelion, grants and personal fees from Bayer, grants and personal fees from Reata, grants and personal fees from Lung Biotechnology Corporation, grants and personal fees from United Therapeutics, outside the submitted work.Conflict of interest: Dr. Roller has nothing to disclose.Conflict of interest: Dr. Seeger reports grants from German Research Foundation, non-financial support from University of Giessen, during the conduct of the study; personal fees from Pfizer, personal fees from Bayer Pharma AG, outside the submitted work.Conflict of interest: Dr. Dumitrescu reports personal fees and other from Actelion, personal fees and other from Novartis, personal fees from Bayer Healthcare, personal fees from GSK, personal fees from MSD, personal fees from Servier, outside the submitted work.Conflict of interest: Dr. Sommer reports personal fees from Actelion, outside the submitted work.Conflict of interest: Dr. Brunst has nothing to disclose.Conflict of interest: Dr. Gall reports grants from German Research Foundation, non-financial support from University of Giessen, during the conduct of the study; personal fees from Actelion, personal fees from AstraZeneca, personal fees from Bayer, personal fees from BMS, personal fees from GSK, personal fees from Janssen-Cilag, personal fees from Lilly, personal fees from MSD, personal fees from Novartis, personal fees from OMT, personal fees from Pfizer, personal fees from United Therapeutics, outside the submitted work.Conflict of interest: Dr. Richter reports grants from German Research Foundation, non-financial support from University of Giessen, during the conduct of the study; grants from United Therapeutics, grants and personal fees from Bayer, personal fees from Actelion, personal fees from Mundipharma, personal fees from Roche, personal fees from OMT, outside the submitted work.