title: Cardiac correlates of exercise induced pulmonary hypertension in patients with chronic heart failure due to left ventricular systolic dysfunction.
abstract: BACKGROUND
  Patients with chronic heart failure (CHF) due to left ventricular systolic dysfunction (LVSD) may develop pulmonary hypertension at rest and during exercise. The cardiac correlates of pulmonary hypertension have been ascertained in the resting state, but seldom during exercise in these patients.
  
  
  OBJECTIVE
  We sought to determine the cardiac correlates of exercise induced pulmonary hypertension in patients with LVSD by monitoring the estimated pulmonary artery systolic pressure (PASP) by continuous Doppler echocardiography during semirecumbent bicycle exercise.
  
  
  METHODS
  Eighty-five patients (mean age 57 +/- 13 years, 75% male) with CHF due to LVSD (LV ejection fraction [EF] <45%, mean LVEF 26 +/- 8%) were studied.
  
  
  RESULTS
  Mitral effective regurgitant orifice area and E-wave were independent predictors of resting PASP. Resting PASP and exercise induced changes in PASP were unrelated (r =-0.08, P = 0.45). Decrease in LV end-systolic volume, increase in left atrial (LA) area, resting LV asynchrony, and decreased tricuspid annular plane systolic excursion (TAPSE) were independent predictors of exercise PASP.
  
  
  CONCLUSIONS
  Resting LV asynchrony, impaired LV contractile reserve, and increase in LA dilatation correlate with the severity of exercise induced pulmonary hypertension in patients with CHF due to LVSD, while right ventricular systolic dysfunction is inversely related to the severity of exercise induced pulmonary hypertension.
authors.affiliation: Physiology Department, Centre Hospitalier Régional et Universitaire de Lille, Lille, France.
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
authors.forename: Claire
authors.initials: C
authors.lastname: Pinçon
authors.forename: Thierry
authors.initials: T
authors.lastname: Le Tourneau
authors.forename: Pascal
authors.initials: P
authors.lastname: de Groote
authors.forename: Clémence
authors.initials: C
authors.lastname: Huerre
authors.forename: Philippe
authors.initials: P
authors.lastname: Asseman
authors.forename: Eric
authors.initials: E
authors.lastname: Van Belle
authors.forename: Rémi
authors.initials: R
authors.lastname: Nevière
authors.forename: Christophe
authors.initials: C
authors.lastname: Bauters
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Deklunder
authors.forename: Thierry H
authors.initials: TH
authors.lastname: Lejemtel
authors.forename: Pierre V
authors.initials: PV
authors.lastname: Ennezat
mesh_terms: D002908:Chronic Disease; D018450:Disease Progression; D015150:Echocardiography, Doppler / Q000379:methods; D005080:Exercise Test / Q000009:adverse effects*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D017725:Ventricular Pressure / Q000502:physiology