Background
Methods
Study subjects
Study protocol
Exercise protocol
CMR equipment, image acquisition, and analysis
Statistical analysis
Results
Baseline characteristics
Parameter | Non-Athletes (n = 15) | CTEPH (n = 15) | Athletes (n = 15) |
P-value |
---|---|---|---|---|
Demographics | ||||
Gender (female) | 3 | 5 | 0 | 0.056 |
Age (years) | 35.1 ± 14.2 | 60.9 ± 15.6 † | 34.6 ± 7.8* | <0.001 |
BSA (m2) | 1.9 ± 0.2 | 1.9 ± 0.3 | 2.0 ± 0.1 | 0.531 |
CPET | ||||
Maximal HR (bpm) | 172.0 ± 18.0 | 131.0 ± 22.9 † | 180.1 ± 10.4* | <0.001 |
Maximal power (Watts) | 221.8 ± 68.2 | 83.2 ± 29.5 † | 376.0 ± 65.0*‡ | <0.001 |
VO2peak (ml/min/kg) | 35.0 ± 7.1 | 13.8 ± 3.0 † | 55.3 ± 10.5*‡ | <0.001 |
Atrial volumes and function at rest and during exercise
Non-Athletes (n = 15) | CTEPH (n = 15) | Athletes (n = 15) |
P-value | ||
---|---|---|---|---|---|
LVEDVi (ml/m2) | Rest Peak Ex | 87.9 ± 16.0 84.1 ± 15.1 | 58.1 ± 11.7 † 51.9 ± 14.8 † | 118.0 ± 12.7*‡ 116.4 ± 13.7*‡ | <0.001 <0.001 |
LVESVi (ml/m2) | Rest Peak Ex | 36.0 ± 9.0 26.3 ± 5.0 | 23.5 ± 8.3 † 18.7 ± 9.8 † | 47.9 ± 9.8*‡ 35.8 ± 8.1*‡ | <0.001 <0.001 |
LVSVi | Rest Peak Ex | 51.9 ± 10.1 57.8 ± 11.8 | 34.6 ± 7.2 † 33.3 ± 10.1 † | 70.1 ± 7.6*‡ 80.6 ± 10.1*‡ | <0.001 <0.001 |
LVEF (%) | Rest Peak Ex | 59.3 ± 5.7 68.6 ± 4.2 | 60.2 ± 9.3 65.2 ± 12.6 | 59.6 ± 5.2 69.3 ± 5.4 | 0.939 0.353 |
RVEDVi (ml/m2) | Rest Peak Ex | 87.8 ± 18.3 80.6 ± 15.1 | 89.3 ± 17.3 100.9 ± 14.1 † | 122.8 ± 20.0*‡ 117.2 ± 24.5 ‡ | <0.001 <0.001 |
RVESVi (ml/m2) | Rest Peak Ex | 37.2 ± 10.0 23.3 ± 6.1 | 57.7 ± 14.8 † 66.3 ± 14.5 † | 52.9 ± 11.8 ‡ 38.6 ± 15.3*‡ | <0.001 <0.001 |
RVSVi | Rest Peak Ex | 50.6 ± 9.8 57.3 ± 11.0 | 31.6 ± 6.4 † 34.6 ± 8.5 † | 69.9 ± 9.9*‡ 78.6 ± 12.3*‡ | <0.001 <0.001 |
RVEF (%) | Rest Peak Ex | 57.9 ± 4.5 71.2 ± 5.0 | 35.8 ± 6.3 † 34.7 ± 8.5 † | 57.2 ± 3.8* 67.9 ± 6.8* | <0.001 <0.001 |
Cardiac Index (l/min/m2) | Rest Peak Ex | 3.4 ± 0.8 8.7 ± 2.1 | 2.6 ± 0.7 † 4.1 ± 1.0 † | 4.1 ± 1.1* 12.3 ± 2.3*‡ | <0.001 <0.001 |
iLAVmax (ml/m2) | Rest Peak Ex | 39.5 ± 10.1 38.3 ± 11.4 | 30.9 ± 9.1 26.3 ± 7.9 † | 55.8 ± 9.2*‡ 53.5 ± 9.7*‡ | <0.001 <0.001 |
iLAVmin (ml/m2) | Rest Peak Ex | 17.7 ± 5.3 13.3 ± 5.6 | 17.2 ± 6.4 15.8 ± 6.7 | 25.6 ± 5.0*‡ 20.2 ± 6.4 ‡ | <0.001 0.023 |
LA Stroke Volume index | Rest Peak Ex | 21.8 ± 6.4 24.9 ± 6.6 | 13.7 ± 4.9 † 10.5 ± 6.6 † | 30.1 ± 5.7*‡ 33.3 ± 8.1*‡ | <0.001 <0.001 |
LAEmF (%) | Rest Peak Ex | 54.9 ± 7.8 66.1 ± 6.4 | 44.6 ± 11.4 † 39.2 ± 20.7 † | 54.0 ± 5.1* 62.1 ± 10.6* | 0.003 <0.001 |
LA reservoir | Rest Peak Ex | 1.29 ± 0.5 2.05 ± 0.60 | 0.88 ± 0.43 † 0.88 ± 0.80 † | 1.20 ± 0.24 1.83 ± 0.80* | 0.020 <0.001 |
iRAVmax (ml/m2) | Rest Peak Ex | 53.4 ± 11.3 44.7 ± 10.7 | 63.6 ± 18.9 78.8 ± 25.8 † | 79.9 ± 19.2*‡ 72.0 ± 21.4 ‡ | <0.001 <0.001 |
iRAVmin (ml/m2) | Rest Peak Ex | 26.4 ± 6.5 16.1 ± 2.9 | 37.8 ± 16.7 54.7 ± 24.9 † | 39.0 ± 12.2 ‡ 26.8 ± 13.7* | 0.016 <0.001 |
RA Stroke Volume Index | Rest Peak Ex | 26.9 ± 7.9 28.5 ± 8.8 | 25.8 ± 5.5 24.2 ± 8.1 | 40.9 ± 9.2*‡ 45.1 ± 12.3 | <0.001 <0.001 |
RAEmF (%) | Rest Peak Ex | 50.1 ± 8.9 63.0 ± 6.4 | 42.6 ± 10.9 32.8 ± 12.8 † | 51.7 ± 6.3* 63.5 ± 11.2* | 0.017 <0.001 |
RA reservoir | Rest Peak Ex | 1.07 ± 0.39 1.78 ± 0.46 | 0.80 ± 0.35 0.54 ± 0.30 † | 1.11 ± 0.31 2.02 ± 1.04* | 0.046 <0.001 |
(RA Volume/LA volume) max | Rest Peak Ex | 1.38 ± 0.20 1.20 ± 0.19 | 2.20 ± 0.86 † 3.21 ± 1.36 † | 1.44 ± 0.30* 1.35 ± 0.32* | <0.001 <0.001 |
RAVmin/RVEDV | Rest Peak Ex | 0.31 ± 0.06 0.20 ± 0.04 | 0.42 ± 0.17 † 0.53 ± 0.23 † | 0.32 ± 0.07* 0.23 ± 0.09* | 0.011 <0.001 |
HR (bpm) | Rest Peak Ex | 66.4 ± 6.7 149.6 ± 11.7 | 76.9 ± 12.4 † 124.2 ± 22.1 † | 58.7 ± 11.9* 154.6 ± 17.8* | <0.001 <0.001 |
Systolic BP (mmHg) | Rest Peak Ex | 137.0 ± 20.5 183.6 ± 31.5 | 137.2 ± 19.3 175.9 ± 36.9 | 140.6 ± 14.2 206.1 ± 31.6 | 0.834 0.057 |
Diastlic BP (mmHg) | Rest Peak Ex | 69.2 ± 10.4 77.5 ± 9.8 | 70.40 ± 12.4 85.57 ± 16.9 | 69.9 ± 6.9 78.9 ± 10.5 | 0.952 0.251 |
Mean PA pressure (mmHg) | Rest Peak Ex | 9.6 ± 2.7 20.6 ± 6.5 | 43.2 ± 10.1 † 65.9 ± 11.0 † | 13.8 ± 4.0* 27.9 ± 8.0* | <0.001 <0.001 |
Mean RA Pressure (mmHg) | Rest Peak Ex | 3 ± 2 (n = 6) 5 ± 2† (n = 6) | 7 ± 4 (n = 10) 17 ± 7 (n = 9) | - - | 0.058 0.002 |
Subgroup analysis: Effect of age on atrial volumes and function
Ventricular function, valvular function and hemodynamics at rest and during exercise
Predictors of VO2peak in the CTEPH group
Univariate analysis | Multivariate analysis | ||||
---|---|---|---|---|---|
Parameter | R |
P-value | Beta |
P-value | |
Age | −0.447 | 0.109 | |||
LVEDVi (ml/m2) | Rest Peak Ex | 0.395 0.464 | 0.162 0.110 | ||
LVESVi (ml/m2) | Rest Peak Ex | 0.435 0.328 | 0.120 0.273 | ||
LVEF (%) | Rest Peak Ex | −0.305 −0.072 | 0.289 0.816 | ||
RVEDVi(ml/m2) | Rest Peak Ex | −0.192 0.047 | 0.510 0.880 | ||
RVESVi (ml/m2) | Rest Peak Ex | −0.193 −0.217 | 0.509 0.477 | ||
RVEF (%) | Rest Peak Ex | 0.046 0.406 | 0.876 0.168 | ||
Cardiac Index (l/m2) | Rest Peak Ex | 0.043 0.620 | 0.885 0.024 | ||
iLAVmax (ml/m2) | Rest Peak Ex | −0.135 0.056 | 0.646 0.862 | ||
iLAVmin (ml/m2) | Rest Peak Ex | −0.116 −0.631 | 0.692 0.028 | −0.515 | 0.018 |
LAEmF (%) | Rest Peak Ex | −0.045 0.640 | 0.879 0.025 | ||
LA reservoir | Rest Peak Ex | −0.041 0.637 | 0.888 0.026 | ||
iRAVmax (ml/m2) | Rest Peak Ex | −0.436 −0.170 | 0.119 0.598 | ||
iRAVmin (ml/m2) | Rest Peak Ex | −0.410 −0.377 | 0.146 0.227 | ||
RAEmF (%) | Rest Peak Ex | 0.268 0.684 | 0.354 0.014 | 0.581 | 0.003 |
RA reservoir | Rest Peak Ex | 0.264 0.643 | 0.361 0.024 |