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

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 e...

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Published in:	Circulation. Cardiovascular imaging Vol. 9; no. 11
Main Authors:	Kim, Jiwon, Di Franco, Antonino, Seoane, Tania, Srinivasan, Aparna, Kampaktsis, Polydoros N, Geevarghese, Alexi, Goldburg, Samantha R, Khan, Saadat A, Szulc, Massimiliano, Ratcliffe, Mark B, Levine, Robert A, Morgan, Ashley E, Maddula, Pooja, Rozenstrauch, Meenakshi, Shah, Tara, Devereux, Richard B, Weinsaft, Jonathan W
Format:	Journal Article
Language:	English
Published:	United States 01-11-2016
Subjects:	Aged Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - epidemiology Coronary Artery Disease - physiopathology Coronary Circulation Echocardiography, Doppler Echocardiography, Stress - methods Exercise Test Exercise Tolerance Female Humans Male Middle Aged Myocardial Contraction Myocardial Perfusion Imaging - methods New York City - epidemiology Predictive Value of Tests Prevalence Reproducibility of Results Time Factors Tomography, Emission-Computed, Single-Photon Ventricular Dysfunction, Left - diagnostic imaging Ventricular Dysfunction, Left - epidemiology Ventricular Dysfunction, Left - physiopathology Ventricular Dysfunction, Right - diagnostic imaging Ventricular Dysfunction, Right - epidemiology Ventricular Dysfunction, Right - physiopathology Ventricular Function, Left Ventricular Function, Right heart failure exercise exercise tolerance exercise test echocardiography
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Summary:	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. 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. 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1941-9651 1942-0080
DOI:	10.1161/CIRCIMAGING.116.005115