Role of right ventricle and dynamic pulmonary hypertension on determining ΔVO2/Δwork rate flattening

Francesco Bandera, Greta Generati, Marta Pellegrino, Valeria Donghi, Eleonora Alfonzetti, Maddalena Gaeta, Simona Villani, Marco Guazzi

Research output: Contribution to journalArticlepeer-review


Background-Several cardiovascular diseases are characterized by an impaired O2 kinetic during exercise. The lack of a linear increase of &utrioxygen consumption (VO2)/ΔWork Rate (WR) relationship, as assessed by expired gas analysis, is considered an indicator of abnormal cardiovascular efficiency. We aimed at describing the frequency of ΔVO2/ΔWR flattening in a symptomatic population of cardiac patients, characterizing its functional profile, and testing the hypothesis that dynamic pulmonary hypertension and right ventricular contractile reserve play a major role as cardiac determinants. Methods and Results-We studied 136 patients, with different cardiovascular diseases, referred for exertional dyspnoea. Cardiopulmonary exercise test combined with simultaneous exercise echocardiography was performed using a symptomlimited protocol. ΔVO2/ΔWR flattening was observed in 36 patients (group A, 26.5% of population) and was associated with a globally worse functional profile (reduced peak VO2, anaerobic threshold, O2 pulse, impaired VE/VCO2). At univariate analysis, exercise ejection fraction, exercise mitral regurgitation, rest and exercise tricuspid annular plane systolic excursion, exercise systolic pulmonary artery pressure, and exercise cardiac output were all significantly (P〈0.05) impaired in group A. The multivariate analysis identified exercise systolic pulmonary artery pressure (odds ratio, 1.06; confidence interval, 1.01-1.11; P=0.01) and exercise tricuspid annular plane systolic excursion (odds ratio, 0.88; confidence interval, 0.80-0.97; P=0.01) as main cardiac determinants of ΔVO2/ΔWR flattening; female sex was strongly associated (odds ratio, 6.10; confidence interval, 2.11-17.7; P〈0.01). Conclusions-In patients symptomatic for dyspnea, the occurrence of ΔVO2/ΔWR flattening reflects a significantly impaired functional phenotype whose main cardiac determinants are the excessive systolic pulmonary artery pressure increase and the reduced peak right ventricular longitudinal systolic function.

Original languageEnglish
Pages (from-to)782-790
Number of pages9
JournalCirculation: Heart Failure
Issue number5
Publication statusPublished - Sep 1 2014


  • Cardiovascular diseases
  • Echocardiography
  • Exercise
  • Hypertension pulmonary
  • Right heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)


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