P1361 Loading conditions might mimic right ventricular longitudinal dysfunction in patients with chronic left heart disease and forward failure

Abstract

Abstract Background and aim Right ventricular failure (RVF) in patients with chronic left heart disease (LHD) has important prognostic implications. RV longitudinal function parameters (tricuspid annular plane systolic excursion, TAPSE; peak systolic longitudinal strain, RV-Str; tricuspid annulus systolic velocity, TAPSm) are today commonly used to define RV dysfunction. In the present study we hypothesized that longitudinal RV dysfunction (LDF) might be due to loading conditions and not necessarily RV dysfunction. Methods We retrospectively included 66 patients with LHD (age 52 ± 13 years, males 79%) that underwent right heart catheterization (RHC), ergospirometry (n = 47) and echocardiography (Echo) within 48 hours. Patients were divided into three groups from Echo data: normal RV function (TAPSE ≥17 mm + normal central venous pressure (CVP) from collapsibility of cava inferior, n = 18); LDF (TAPSE < 17 mm + normal CVP, n = 22) and RVF (CVP≥10 mmHg, n = 26). Results Patients with RVF had compared with normal and LDF lower peak VO2, more advanced LHD, enlarged RV and higher RV afterload (Table). Patients with LDF had compared with normal reduced stroke volume index (SVI). The patients with normal and LDF did not differ regarding right atrial pressure (RAP) response during exercise (P = 0.84). The longitudinal parameters did not differ between patients with LDF and RVF. Conclusions Longitudinal parameters in patients with chronic LHD and normal CVP should be interpreted with caution. Loading conditions with reduced stroke volume might mimic LDF. Normal (n = 18) LDF (n = 22) RVF (n = 26) Overall P-value Normal vs LDF Normal vs RVF LDF vs RVF Peak VO2 (mlO2/min/m2) 14.8 ± 3.3 13.5 ± 3 11 ± 2 0.001 0.29 <0.001 0.005 RAP (mmHg) 4 ± 3 4 ± 4 12 ± 3 <0.001 0.55 <0.001 <0.001 PASP (mmHg) 32 ± 13 37 ± 14 47 ± 11 <0.001 0.28 <0.001 0.002 PCWP (mmHg) 10 ± 6 14 ± 7 22 ± 5 <0.001 0.03 <0.001 <0.001 SVI(ml/m2) 43 ± 10 34 ± 6 30 ± 9 <0.001 <0.001 <0.001 0.15 PVR (Wood unit) 2.0 ± 1.1 2.0 ± 0.8 2.3 ± 1.1 0.29 - - - RVdA (cm2) 19 ± 3 22 ± 7 26 ± 7 0.003 0.16 <0.001 0.04 RVsax (mm) 23 ± 4 25 ± 8 34 ± 8 <0.001 0.42 <0.001 <0.001 TAPSE (mm) 21 ± 4 12 ± 3 12 ± 3 <0.001 <0.001 <0.001 0.98 TAPSm (cm/s) 11 ± 3 8 ± 2 8 ± 2 <0.001 <0.001 <0.001 0.55 RV-Str (%) -24 ± 5 -16 ± 5 -15 ± 5 <0.001 <0.001 <0.001 0.87 PASP, pulmonary systolic pressure; PCWP, pulmonary capillary wedge pressure; PVR, pulmonary vascular resistance; RVdA, RV diastolic area; RVsax, RV short axis diameter.