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Exercise-Related Mitral Regurgitation and Right Ventricle to Pulmonary Circulation Uncoupling Across the Heart Failure Phenotypes
American Journal of Physiology-Heart and Circulatory Physiology ( IF 4.8 ) Pub Date : 2020-12-11 , DOI: 10.1152/ajpheart.00507.2020
Francesco Bandera 1, 2 , Marta Barletta 1 , Marianna Fontana 3 , Sara Boveri 4 , Greta Ghizzardi 1 , Eleonora Alfonzetti 1 , Federico Ambrogi 5 , Marco Guazzi 1, 2
Affiliation  

Exercise-related mitral regurgitation (Ex-MR) is one of the mechanisms that contribute to reduced functional capacity in heart failure (HF). Its prevalence is not well defined across different HF subtypes. The aim of the present study is to describe functional phenotypes and cardiac response to exercise in HFrEF, HFmrEF and HFpEF, according with Ex-MR prevalence. A total of 218 HF patients (146 men, 68[59-78] years), 137 HFrEF, 41 HFmrEF, 40 HFpEF and 23 controls were tested with cardiopulmonary exercise test combined with exercise-echocardiography. Ex-MR was defined as development of at least moderate (³2+/4+) regurgitation during exercise. Ex-MR was highly prevalent in the overall population (52%) although the prevalence differed as follows: 82/137(60%) in HFrEF, 17/41(41%) in HFmrEF and 14/40(35%) in HFpEF (p< .05). Ex-MR was associated with a high rate of ventilation (VE) to carbon dioxide production (VCO2) in all HF subtypes (31.2[26.6-35.6] vs 33.4[29.6-40.5], p=0.004; 28.1[24.5-31.9] vs 34.4[28.2-36.7], p=0.01; 28.8[26.6-32.4] vs 32.2[29.2-36.7], p=0.01) and with lower peakVO2 in HFrEF and HFmrEF. Right ventricle to pulmonary circulation (RV-PC) uncoupling was observed during exercise in HFrEF and HFpEF patients (peak TAPSE/SPAP: HFrEF 0.40[0.30-0.57]vs0.29[0.23-0.39],p=0.006; HFpEF 0.44[0.28-0.62]vs0.31[0.27-0.33],p=0.05). HFpEF with Ex-MR showed a distinct phenotype characterized by better chronotropic reserve and peripheral O2 extraction. The Ex-MR is a common mechanism across all HF subtypes, associated with ventilatory inefficiency and RV-PC uncoupling. In HFpEF, Ex-MR is unexpectedly prevalent and associated with increased chronotropic response and peripheral O2 extraction as potential adaptive mechanisms to backward flow redistribution.

中文翻译:

与运动有关的二尖瓣反流和右心室与跨心力衰竭表型的肺循环解耦

与运动有关的二尖瓣关闭不全(Ex-MR)是导致心力衰竭(HF)功能降低的机制之一。在不同的HF亚型中,其患病率尚不明确。本研究的目的是根据Ex-MR患病率描述HFrEF,HFmrEF和HFpEF对运动的功能表型和心脏反应。通过心肺运动试验结合运动超声心动图对总共218名HF患者(146名男性,68 [59-78]岁),137名HFrEF,41名HFmrEF,40名HFpEF和23名对照进行了测试。Ex-MR定义为运动期间至少出现中度(³2+ / 4 +)反流。前MR在总人群中高度流行(52%),尽管患病率差异如下:HFrEF中为82/137(60%),HFmrEF中为17/41(41%),HFpEF中为14/40(35%) (p <.05)。2)在所有HF亚型中(31.2 [26.6-35.6] vs 33.4 [29.6-40.5],p = 0.004; 28.1 [24.5-31.9] vs 34.4 [28.2-36.7],p = 0.01; 28.8 [26.6-32.4] vs 32.2 [29.2-36.7],p = 0.01),HFrEF和HFmrEF中的VO 2峰值较低。HFrEF和HFpEF患者在运动过程中观察到右心室至肺循环(RV-PC)的解偶联(峰值TAPSE / SPAP:HFrEF 0.40 [0.30-0.57] vs0.29 [0.23-0.39],p = 0.006; HFpEF 0.44 [0.28 -0.62] vs0.31 [0.27-0.33],p = 0.05)。带有Ex-MR的HFpEF表现出独特的表型,其特征是具有更好的变时性储备和外围O 2提取。Ex-MR是所有HF亚型的常见机制,与通气效率低下和RV-PC解偶联有关。在HFpEF中,Ex-MR出乎意料地盛行,并与变时性反应增加和周围O2提取作为潜在的自适应机制,可以反向分配流量。
更新日期:2020-12-12
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