IMPAIRED PULMONARY HEMODYNAMIC-RIGHT VENTRICULAR COUPLING DURING EXERCISE IN PATIENTS WITH HEART FAILURE AND EXERCISE OSCILLATORY VENTILATION

Background Right ventricular (RV) dysfunction and RV-pulmonary circulation uncoupling importantly determines clinical course and prognosis in heart failure (HF). Echo-derived pulmonary artery systolic pressure (PASP) and tricuspid annular systolic excursion (TAPSE) are remarkable prognostic markers. We investigated the pulmonary circulation pressure-RV coupling during exercise by looking at the relationship between PASP and TAPSE (rest and peak exercise) in HF patients with exercise oscillatory ventilation (EOV) vs no-EOV. Methods and Results 16 HF patients (mean age 67.8±8.9; male 31 %) with systolic dysfunction (mean left ventricle EF 32±10%) with no-EOV (n=10) and EOV (n=6) underwent a maximal cardiopulmonary exercise testing evaluation (bike, incremental ramp protocol) combined with Echo-Doppler assessment. Table shows the main Results. Both rest and peak mean PASP/TAPSE ratio in EOV patients resulted worse than the peak ratio in no-EOV, meanings an unfavorable pulmonary pressure- RV function coupling and dynamic pulmonary hypertension. Conclusions The abnormal pattern of EOV is associated with a higher degree of pulmonary circulation/RV function uncoupling (PASP/TAPSE ratio) both at rest and peak exercise with a corresponding impaired ventilation efficiency (VE/VC02 slope) and overall exercise performance (peak VO2). These findings provide a rationale for proposing a systematic combined evaluation of Echo-derived RV functional data and gas exchange during exercise.