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Missana A, Azzolini Jacquin M, Baudouy D, Sanfiorenzo C, Leroy S, Sermesant M, Ferrari E, Moceri P. P1397 Rehabilitation in pulmonary arterial hypertension: REHAB-HTP. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Pulmonary arterial hypertension (PAH) is a life-threatening condition. Current ESC guidelines recommend exercise training and rehabilitation in clinically stable PAH patients.
PURPOSE
To assess the beneficial effect of exercise training on exercise capacity, quality of life and cardiac function as assessed by echocardiography and cardio-pulmonary exercise test.
METHODS
We prospectively included 12 clinically stable PAH patients over a 6 months period. Exercise stress echocardiography (ESE), cardio-pulmonary exercise test (CPET), SF-12 quality of life health survey, 6 minute walking test distance (6MWD), BNP and clinical assessment were performed before and after cardio-pulmonary rehabilitation. Patients underwent 8 weeks of exercise training (3 times a week of aerobic training and at home daily prescribed exercises).
RESULTS
All patients underwent ESE and CPET without any complication. 6 patients experienced a reduction in WHO functional class whereas 6 remained stable. Patients significantly improved their physical quality of life (p = 0.006). They also improved their exercise capacity according to maximum workload during CPET (p = 0.008) and CPET duration (p = 0.001) whereas a trend toward an improved 6MWD was observed (+58m, p = 0.10). Anaerobic threshold and peak VO2 (+1.7 ± 2.7 mL/kg/min) improved significantly (p = 0.01 and 0.03). Regarding imaging data, at rest peak strain improved after rehabilitation (p = 0.05) whereas the RV became more dilated. RV contractile reserve, defined by the change in peak systolic longitudinal RV strain between rest and maximum exercise, significantly improved (-3.9 ± 4.7%, p = 0.03)
CONCLUSION
In this preliminary study, cardio-pulmonary rehabilitation led to an improved quality of life and exercise capacity in PAH. The increased in RV contractile reserve post-rehabilitation might explain, in association with the peripheral muscular effects of exercise training, the clinical benefits of rehabilitation in PAH.
Abstract P1397 Figure. echography peak/rest in a PAH patient
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Affiliation(s)
- A Missana
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | | | - D Baudouy
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - C Sanfiorenzo
- University Hospital Pasteur of Nice, pneumology, Nice, France
| | - S Leroy
- University Hospital Pasteur of Nice, pneumology, Nice, France
| | - M Sermesant
- Equipe Epione, INRIA, sophia antipolis, France
| | - E Ferrari
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - P Moceri
- University Hospital Pasteur of Nice, cardiology, Nice, France
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Missana A, Azzolini Jacquin M, David C, Baudouy D, Sartre B, Sanfiorenzo C, Wehrlin C, Sermesant M, Ferrari E, Moceri P. P941 Evaluation of right ventricular contractile reserve with exercise stress echocardiography. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Right ventricular (RV) contractile reserve reflects the ability of the RV to adapt to elevated afterload. RV functional response to exercise is challenging but could represent an important prognostic factor, especially in pulmonary arterial hypertension (PAH) patients. We aimed, using exercise stress echocardiography (ESE), to assess different RV contractile reserve evaluation methods in a cohort of PAH patients and controls.
METHODS
We prospectively included 12 patients with PAH and 12 healthy volunteers. An ESE (using tilt-table ergometer) was performed in all patients to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. 3D RV function as well as peak systolic strain, pulmonary pressures, TAPSE, pulmonary TVI and pulmonary output (using the right ventricular outflow tract diameter) were assessed in all patients.
RESULTS
Our patient group was composed by PAH patients, 61.5 ± 14.8 years; mean age of our control group was 29.33 ± 5.5 years. PAH patients achieved an exercise with a mean workload of 69.17 ± 26.4 Watts. There was no complication after the exercise test in all patients. Change in TAPSE was not significantly different between patients and controls (p = 0.17), whereas change in pulmonary TVI, pulmonary output and RV peak systolic strain was highly discriminant (respectively p = 0.03, p = 0.009 and p = 0.0009). Regarding RV contractile reserve parameters, RV end-systolic pressure area ratio (peak/rest) was not statistically different between controls and patients (p = 0.14) whereas change in TAPSE/sPAP, RV peak strain/sPAP, 3D RV EF/sPAP were significantly different (p = 0.005, p= 0.0008, p = 0004).
CONCLUSION
Changes in pulmonary output, RV peak systolic strain as well as changes in TAPSE/sPAP but mainly RV peak strain/sPAP, 3D RV EF/sPAP represent consistent and feasible tools to assess RV contractile reserve.
echocardiographic parameters PAH (n = 12) Healthy Controls (n = 12) p value sPAP at rest (mmHg) 40.91 ± 10.7 15.42 ± 4.1 <0.001 sPAP at peak (mmHg) 82.50 ± 21.7 42.50 ± 17.8 <0.001 TAPSE at rest/sPAP at rest (mm/mmHg) 0.62 ± 0.2 1.72 ± 0.6 <0.001 TAPSE at peak /sPAP at peak 0.36 ± 0.1 0.80 ± 0.2 <0.001 ΔStrain (%) 3.43 ± 3.1 8.08 ± 2.8 <0.001 Δ(peak Strain/sPAP) -0.17 ± 0.2 -0.77 ± 0.4 <0.001 Δpulmonary TVI (cm) 3.88 ± 4.0 7.46 ± 3.5 0.03 Δ(RVEF/sPAP) -0.34 ± 0.4 -2.06 ± 1.7 <0.001
Abstract P941 Figure. echography (rest/peak) PAH patient
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Affiliation(s)
- A Missana
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | | | - C David
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - D Baudouy
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - B Sartre
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - C Sanfiorenzo
- University Hospital Pasteur of Nice, pneumology, Nice, France
| | - C Wehrlin
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - M Sermesant
- Equipe Epione, INRIA, sophia antipolis, France
| | - E Ferrari
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - P Moceri
- University Hospital Pasteur of Nice, cardiology, Nice, France
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