Pulmonary vascular disease & thromboembolism
Exercise Right Atrial Stiffness From Pressure-Volume Loops and Prognosis in Pulmonary Hypertension
Authors' conclusion
RA stiffness during exercise integrates resting congestion with limited cardiac reserve and unmasks mortality risk missed by resting metrics. RA conduit strain and right ventricular functional reserve noninvasively identify the high-stiffness subgroup.
Study context
- Population
- Participants undergoing evaluation with 3-dimensional echocardiography, right heart catheterization, and invasive right atrial (RA) pressure-volume loop analysis at rest and during standardized semisupine exercise, including patients with precapillary pulmonary hypertension (PH), participants who had PH ruled out and patients with postcapillary PHparticipants enrolled · precapillary PH 42
- Participants
- 68 participants
- Exposure
- High- vs low-stiffness groups: patients with precapillary PH stratified by median exercise RA filling stiffness
- Outcome
- Right ventricular function, afterload, and cardiac index
- Follow-up
- At rest
Methodological detailsprospectively enrolled
- Prospectively enrolled
Main finding
As reported in the abstract
- High- and low-stiffness groups had comparable right ventricular function, afterload, and cardiac index
Observational data: associations, not effects.
Further findings
Mortality
| Adjusted hazard ratio (95% CI) | ||
|---|---|---|
| High exercise RA stiffness | 4.37 (1.20–15.96) | |
| 0.050.21520Adjusted hazard ratio (log scale) |
| Outcome | High-stiffness group | Low-stiffness group | P value |
|---|---|---|---|
| Liver stiffness (venous congestion) · At restHigh-stiffness group vs Low-stiffness group | median 7.1 (IQR 6.0–8.8) kPa | median 5.2 (IQR 4.8–5.8) kPa | P = 0.021 |
| Peak cardiac index · During exerciseHigh-stiffness group vs Low-stiffness group · impaired in the high-stiffness group | 3.3 ± 1.0 L/min per m² | 4.1 ± 0.9 L/min per m² | P = 0.015 |
- Mortality: independently associated with mortality, unlike resting RA stiffness
Phasic RA strain · At rest
- The high-stiffness group exhibited impaired phasic RA strain
Mean RA pressure · During exercise
- Mean RA pressure increased similarly
RA strain · During exercise
- The high-stiffness group had impaired RA strain
Discrimination of high RA stiffness
- Model including RA conduit strain and right ventricular functional reserve, area under the receiver operating characteristic curve
- 0.90
Original publication
Exercise Right Atrial Stiffness From Pressure-Volume Loops and Prognosis in Pulmonary Hypertension. Circ Heart Fail. Published 2 November 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →