Comportamiento de la presión pulmonar y función del ventrículo derecho intraesfuerzo;
Pulmonary Artery Pressure and Right Ventricular Function during Exercise

IntroducciónEl comportamiento fisiológico de la presión pulmonar durante el ejercicio continúa sin establecerse con precisión. La literatura es discordante con respecto a los valores considerados patológicos de presión pulmonar intraesfuerzo (PPI) en ausencia de valvulopatía mitral e incluso, las últimas guías no recomiendan utilizar la presión pulmonar media ≥ 30 mmHg con el esfuerzo para definir hipertensión pulmonar. Es escasa la información disponible en relación a la respuesta hemodinámica y funcional del ventrículo derecho (VD) con el esfuerzo y tampoco  sobre el hecho de si podría discriminar entre una respuesta fisiológica o patológica de la presión pulmonar.  ObjetivoDeterminar el comportamiento de la PPI y comparar los parámetros ecocardiográficos de función sistólica y diastólica del VD en relación a sus niveles. Material y métodosSe incluyeron 94 pacientes sin cardiopatías significativas, con adecuada factibilidad para estimar presión pulmonar sistólica (PPS) basal y en máxima carga durante el ecoestrésen ejercicio. De acuerdo al valor de presión pulmonar con el ejercicio, la población fue estratificada en dos grupos:a) PPI <50 mmHg (56)b) PPI ≥50 mmHg (38). Se compararon las variables de función sistólica (onda S del Doppler tisular) y diastólica (Doppler pulsado en tracto de entrada y Doppler tisular de pared lateral) del VD.  

BackgroundThe physiological behavior of pulmonary artery pressure during exercise has not been precisely established yet. There is lack of agreement in the published literature about the abnormal values of pulmonary artery pressure (PAP) during exercise in the absence of mitral valve disease. Indeed, the last guidelines do not recommend using mean pulmonary artery pressure value ≥ 30 mmHg during exercise to define pulmonary hypertension. There is scarce information about the hemodynamic and functional response of the right ventricle (RV) during exercise and if it is useful to discriminate between a physiological or abnormal response of the pulmonary artery pressure.  ObjectivesTo determine the behavior of PAP during exercise and to compare the echocardiographic parameters of systolic and diastolic RV function in relation to PAP levels.  ResultsPAP ≥50 mm mmHg This value was associated with greater age, female gender and elevated values of SPAP at rest. The parameters of RV diastolic function did not present significant differences. The group with PAP ≥ 50 mmHg during exercise presented a less increase in the S-wave measured by tissue Doppler imaging as an expression of a compensatory reduced RV contractile performance.During exercise, 40% of the analyzed population reached a ConclusionsA high percentage of the population developed PAP ≥50 mmHgduring exercise. The variables of RV diastolic function did not show significant differences and the group with PAP ≥50 mmHg during exercise presented compensatory reduced RV contractile performance as an expression of subclinical dysfunction.Material and MethodsA total of 94 patients without significant heart disease were included. Systolic pulmonary artery pressure (SPAP) at rest and maximum exercise during dobutamine stress echocardiography was adequately measured in all patients. The population was divided into two groups according to the value of pulmonary artery pressure during exercise: a) PAP <50 mmHg (56) b) PAP ≥50 mmHg (38). We also compared the variables of RV systolic function (S-wave measured by tissue Doppler imaging) and diastolic function (using pulsed Doppler echocardiography in the inlet tract and tissue Doppler echocardiography in the lateral wall).