Right ventricular reserve in cardiopulmonary disease: A simultaneous hemodynamic and three-dimensional echocardiographic study

Background: Right ventricular (RV) reserve has been linked to exercise capacity and prognosis in cardiopulmonary diseases. However, evidence in this setting is limited, due to the complex shape and load dependency of the RV. We sought to study RV adaptation to exercise by simultaneous three-dimensional echocardiography (3DE) and right heart catheterization (RHC). Methods: Patients with heart failure with preserved ejection fraction (HFpEF) or pulmonary vascular disease (PVD) underwent simultaneous supine rest/exercise RHC-3DE. They were subdivided based on RV ejection fraction (EF) changes: (1) exhausted RV reserve, RVEF-; (2) preserved RV reserve, RVEF+. Results: Sixty percent of patients were RVEF-. Distribution of HFpEF/PVD, as well as RV volumes and RVEF at rest were similar in the 2 groups. Hemodynamic metrics of RV afterload, as well as their exercise-induced changes, were similar in the 2 groups. During exercise, RV end-diastolic volume increased more in RVEF- than in RVEF+ (29 ...