Abstract Background Right ventricular–pulmonary circulation (RV-PC coupling) serves as an index to evaluate RV function in relation to underlying RV afterload. Although impaired RV-PC coupling has been proposed as a predictor of adverse outcomes in heart failure (HF) patients with secondary mitral regurgitation (MR), there is limited data available for patients with primary MR and moreover, if there is a sex-related trend. Purpose This study aimed to assess RV-PC coupling at rest and during exercise with bicycle stress echocardiography in patients with asymptomatic moderate to severe primary MR and compare these alterations between men and women. Methods All patients and controls underwent stress echocardiography with a supine bicycle. RV systolic function was evaluated with TAPSE and S’. The non-invasively measured RV-PC coupling was evaluated by indexing TAPSE to right ventricular systolic pressure (RVSP) during baseline echocardiogram and peak workload stages of bicycle SE. Results Among the 48 patients, 28 (58%) were women and 20 (42%) were men (mean age 54.07+14.16 and 52.7±16.81 years, p. NS, respectively). 39 patients had moderate MR (81.3%), 5 patients had moderate-to-severe MR(10.4%), and 4 patients had severe MR(8.3%). The duration of stress echocardiogram was significantly longer in the male MR group (9.32+1.62 min vs 7.22+2.50 min, respectively; p .001). Left Ventricular Ejection Fraction (LVEF) was within normal limits in both groups {67.59+13.71 % vs 72.93+10.21 %(p=NS)} and the dimensions of left ventricular cavity (end-diastolic and end-systolic diameters) were significantly larger in the male group compared to female group (51.5+5.10 mm vs 47.64+4.73mm (p .011) and 34.00+4.06mm vs 30.25+3.74mm (p .002) respectively}. TAPSE and RVSP increased from baseline to peak dose for both men [Rest: 22.95±2.93mm and 14.13±1.99cm/sec (p. NS) respectively, Peak exercise: 29.55 ±3.41mm and 20.84±2.00cm/sec (p. NS) respectively] and women [Rest: 23.86±3.13 and 14.54±1.88cm/sec (p.NS), Peak: 30.21±3.56mm and 20.07±2.60cm/sec (p. NS) respectively]. Moreover, a steady decrease was observed in TAPSE/RVSP from baseline to peak workload both in men (0.81±0,13mm/mmHg to 0.75±0.21mm/mmHg) and women (0.86±0.16mm/mmHg to 0.69±0.16mm/mmHg, respectively). Interestingly, a significant change was observed between men and women in TAPSE/RVSP (-0.05±0.17 and -0.16±0.17, p .029 respectively). Conclusions RV-PC coupling decreases during exercise in asymptomatic men and women with moderate to severe MR. Therefore, future studies should aim to evaluate the incremental role of this novel index not only in the assessment and evaluation of men and women with MR but also as a potential prognostic marker between them. TAPSE/RVSP change Graph
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