Dynamic aspects of ventricular interaction during exercise in HFpEF and in pre‐capillary pulmonary hypertension

• Published in: ESC Heart Failure Vol. 10; no. 1; pp. 650 - 660
• Main Authors: Claeys, Mathias, Petit, Thibault, Bogaert, Jan, La Gerche, Andre, Los, Jan, Delcroix, Marion, Willems, Rik, Claessen, Guido, Claus, Piet
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.02.2023; John Wiley and Sons Inc; Wiley
• Subjects: Body mass index; Cardiac catheterization; Cardiac function; Cardiac magnetic resonance; Cardiovascular disease; Catheters; Ejection fraction; Exercise; Heart Failure; HFpEF; Humans; Hypertension, Pulmonary - etiology; Intubation; Original; Pulmonary arteries; Pulmonary Artery; Pulmonary hypertension; Respiration; Right ventricle; Stroke Volume; Variance analysis; Vascular Diseases; Ventricular interdependence; United Kingdom > UK; United States > US; Exercise; HFpEF; Right ventricle; Ventricular interdependence; Cardiac magnetic resonance
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.14216

Aims The contribution of adverse ventricular interdependence remains undervalued in heart failure or pulmonary vascular disease, and not much is known about its dynamic nature during exercise and respiration. In this study, we evaluated ventricular interaction during exercise in patients with heart failure with preserved ejection fraction (HFpEF) and patients with chronic thromboembolic pulmonary hypertension (CTEPH) as compared with healthy controls. Methods and results Forty‐six subjects (10 controls, 19 CTEPH patients, and 17 HFpEF patients) underwent cardiac magnetic resonance imaging during exercise. Ventricular interaction was determined through analysis of the septal curvature (SC) of a mid‐ventricular short‐axis slice at end‐diastole, end‐systole, and early‐diastole, both in expiration and inspiration. Exercise amplified ventricular interaction in CTEPH patients and to a lesser extent in HFpEF patients (P < 0.05 for decrease in SC with exercise). Adverse interaction was most profound in early‐diastole and most pronounced in CTEPH patients (P < 0.05 interaction group * exercise) because of a disproportionate increase RV afterload (P < 0.05 to both controls and HFpEF) and diastolic pericardial restraint (P < 0.001 for interaction group * exercise) during exercise. Inspiration enhanced diastolic interdependence in CTEPH and HFpEF patients (P < 0.05 vs. expiration). Both at rest and during exercise, SC strongly correlated with RV volumes and pulmonary artery pressures (all P < 0.05). Conclusions Exercise amplifies adverse right–left ventricular interactions in CTEPH, while a more moderate effect is observed in isolated post‐capillary HFpEF. Given the strong link with RV function and pulmonary hemodynamic, assessing ventricular interaction with exCMR might be valuable from a diagnostic or therapeutic perspective.