Page 190 - Assessing right ventricular function and the pulmonary circulation in pulmonary hypertension Onno Anthonius Spruijt

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developed as an alternative technique for the characterization of the interventricular insertion regions with the advantage of not requiring the use of contrast agents.
Patients with pulmonary hypertension have a decreased exercise tolerance. This exercise intolerance in mainly determined by circulatory limitations. Whether this exercise intolerance coincided with an inability to increase right ventricular contractility was investigated in chapter 10 using an invasive cardiopulmonary exercise test. We prospectively included patients with precapillary PH and control subjects. The rest-to-exercise change in load-independent measures of right ventricular contractility, the contractile reserve, as well as the rest-to-exercise change in the coupling between the right ventricle and its load (right ventricular arterial coupling) were assessed using single beat pressure-volume loop analysis. We found that, in contrast to controls, pulmonary hypertension patients have no contractile reserve. Failure to compensate for the rest-to-exercise increase in load on the right ventricle led to a deterioration in right ventricular arterial coupling during exercise. Furthermore, we found that the contractile reserve was not related to a recently proposed surrogate, the rest-to-exercise change in pulmonary artery pressure.