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: | , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
01-11-2016
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| Abstract | 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. |
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| AbstractList | 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. BACKGROUNDRight 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 RESULTSThe 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.CONCLUSIONSAmong 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. |
| Author | Szulc, Massimiliano Maddula, Pooja Devereux, Richard B Khan, Saadat A Goldburg, Samantha R Rozenstrauch, Meenakshi Seoane, Tania Geevarghese, Alexi Levine, Robert A Kim, Jiwon Morgan, Ashley E Srinivasan, Aparna Kampaktsis, Polydoros N Shah, Tara Ratcliffe, Mark B Weinsaft, Jonathan W Di Franco, Antonino |
| AuthorAffiliation | 3 Division of Cardiology, Department of Surgery, University of California, San Francisco; Department of Bioengineering, University of California, San Francisco; Veterans Affairs Medical Center (San Francisco, CA) 1 Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College (New York, NY) 4 Massachusetts General Hospital, Harvard Medical School (Boston, MA) 2 Department of Cardiothoracic Surgery, Weill Cornell Medical College (New York, NY) |
| AuthorAffiliation_xml | – name: 1 Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College (New York, NY) – name: 3 Division of Cardiology, Department of Surgery, University of California, San Francisco; Department of Bioengineering, University of California, San Francisco; Veterans Affairs Medical Center (San Francisco, CA) – name: 2 Department of Cardiothoracic Surgery, Weill Cornell Medical College (New York, NY) – name: 4 Massachusetts General Hospital, Harvard Medical School (Boston, MA) |
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| PublicationTitleAlternate | Circ Cardiovasc Imaging |
| PublicationYear | 2016 |
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| References_xml | – ident: e_1_3_3_5_2 doi: 10.1016/0167-5273(90)90315-V – ident: e_1_3_3_21_2 doi: 10.1016/j.echo.2016.05.002 – ident: e_1_3_3_29_2 doi: 10.1016/S0894-7317(03)00335-3 – ident: e_1_3_3_15_2 doi: 10.1007/s12350-016-0463-x – ident: e_1_3_3_26_2 doi: 10.1016/S0002-8703(03)00229-1 – ident: e_1_3_3_19_2 doi: 10.1016/0735-1097(93)90557-H – ident: e_1_3_3_38_2 doi: 10.1111/echo.12715 – ident: e_1_3_3_33_2 doi: 10.1152/ajpheart.00627.2015 – ident: e_1_3_3_17_2 doi: 10.1016/j.echo.2010.05.010 – ident: e_1_3_3_36_2 doi: 10.1016/0002-9149(84)90256-X – ident: e_1_3_3_3_2 doi: 10.1016/S0735-1097(02)01804-1 – ident: e_1_3_3_20_2 doi: 10.1097/MCA.0000000000000271 – ident: e_1_3_3_14_2 doi: 10.1016/j.amjcard.2005.07.038 – ident: e_1_3_3_31_2 doi: 10.1093/eurheartj/ehi496 – ident: e_1_3_3_6_2 doi: 10.1161/01.CIR.97.6.535 – ident: e_1_3_3_8_2 doi: 10.1001/jama.1989.03430170057028 – ident: e_1_3_3_13_2 doi: 10.1016/j.nuclcard.2007.06.115 – ident: e_1_3_3_11_2 doi: 10.1016/S0735-1097(97)00217-9 – ident: e_1_3_3_30_2 doi: 10.1016/S0002-9149(00)01362-X – ident: e_1_3_3_25_2 doi: 10.1161/01.CIR.55.4.613 – ident: e_1_3_3_35_2 doi: 10.1016/S0735-1097(98)00337-4 – ident: e_1_3_3_28_2 doi: 10.1001/jama.292.19.2350 – ident: e_1_3_3_7_2 doi: 10.1016/j.atherosclerosis.2007.07.002 – ident: e_1_3_3_22_2 doi: 10.1016/S0735-1097(99)00396-4 – ident: e_1_3_3_16_2 doi: 10.1016/j.amjcard.2014.05.008 – ident: e_1_3_3_27_2 doi: 10.1016/j.echo.2007.05.008 – ident: e_1_3_3_4_2 doi: 10.1161/CIRCULATIONAHA.113.002518 – ident: e_1_3_3_24_2 doi: 10.1016/0002-9149(86)90771-X – ident: e_1_3_3_10_2 doi: 10.1161/01.CIR.98.25.2836 – volume: 18 start-page: 539 year: 2002 ident: e_1_3_3_18_2 article-title: Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. publication-title: Int J Cardiovasc Imaging contributor: fullname: Cerqueira MD – ident: e_1_3_3_23_2 doi: 10.1016/j.echo.2014.10.003 – ident: e_1_3_3_2_2 doi: 10.1016/j.amjcard.2007.09.115 – ident: e_1_3_3_12_2 doi: 10.1056/NEJMoa052256 – ident: e_1_3_3_37_2 doi: 10.1016/0735-1097(94)00511-N – ident: e_1_3_3_9_2 doi: 10.1056/NEJMoa011858 – ident: e_1_3_3_32_2 doi: 10.1016/j.jacc.2006.10.056 – ident: e_1_3_3_34_2 doi: 10.1097/HCR.0000000000000086 |
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| Snippet | Right ventricular (RV) and left ventricular (LV) function are closely linked due to a variety of factors, including common coronary blood supply. Altered LV... BACKGROUNDRight ventricular (RV) and left ventricular (LV) function are closely linked due to a variety of factors, including common coronary blood supply.... |
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| SubjectTerms | 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 |
| Title | Right Ventricular Dysfunction Impairs Effort Tolerance Independent of Left Ventricular Function Among Patients Undergoing Exercise Stress Myocardial Perfusion Imaging |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/27903538 https://search.proquest.com/docview/1845251315 https://pubmed.ncbi.nlm.nih.gov/PMC5137788 |
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