{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T05:46:19Z","timestamp":1782193579437,"version":"3.54.5"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Acute and chronic effects of cardiac resynchronization therapy (CRT) on pulmonary pressures, right ventricular function, and ventricular-vascular coupling during exercise are insufficiently understood. Yet, these factors are strongly associated with functional status and outcome.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p>\n              Heart failure patients with reduced ejection fraction indicated for CRT were prospectively included to undergo exercise echocardiography simultaneously with cardiopulmonary exercise testing before (pre_CRT), 1 day after (post_CRT), and 6 months (post6_CRT) after CRT implant. Right ventricular-arterial coupling was assessed by the tricuspid annular plane systolic excursion (TAPSE)\/systolic pulmonary artery pressure (SPAP) ratio. A total of 31 heart failure patients with reduced ejection fraction (age=66\u00b113 years) were prospectively included. CRT resulted in an immediate reduction in rest SPAP (pre_CRT=32\u00b116 versus post_CRT=23\u00b116 mm\u2009Hg;\n              <jats:italic>P<\/jats:italic>\n              =0.006) and rest effective regurgitant orifice (pre_CRT=0.32\u00b10.1 versus post_CRT=0.18\u00b10.2;\n              <jats:italic>P<\/jats:italic>\n              =0.001) without changes in exercise mitral regurgitation or exercise SPAP indexed for cardiac output. Six months after CRT, in parallel with left ventricular reverse remodeling and a reduction in exercise mitral regurgitation and exercise E\/e\u2032 ratio, the exercise SPAP\/cardiac output significantly improved (post_CRT=5.6\u00b13.1 versus post6_CRT=4.3\u00b12.9 mm\u2009Hg\u00b7L\n              <jats:sup>\u22121<\/jats:sup>\n              \u00b7min\n              <jats:sup>\u22121<\/jats:sup>\n              ;\n              <jats:italic>P<\/jats:italic>\n              =0.039), which was also illustrated by a reduced slope of \u0394SPAP\/\u0394cardiac output (post_CRT=5.2\u00b13.7 versus post6_CRT=2.9\u00b12.7 mm\u2009Hg\u00b7L\n              <jats:sup>\u22121<\/jats:sup>\n              \u00b7min\n              <jats:sup>\u22121<\/jats:sup>\n              ;\n              <jats:italic>P<\/jats:italic>\n              =0.002). CRT did not result in an acute or chronic effect on TAPSE or TAPSE\/SPAP ratio at rest. However, exercise revealed the presence of right ventricular-arterial uncoupling which was not affected by an acute CRT effect (\n              <jats:italic>P<\/jats:italic>\n              =0.396) but only improved by a chronic CRT effect (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001; TAPSE\/SPAP ratio: pre_CRT= 0.39\u00b10.6 mm\/mm\u2009Hg; post_CRT=0.42\u00b10.5 mm\/mm\u2009Hg; post6_CRT =0.84\u00b10.12 mm\/mm\u2009Hg). Of all exercise echocardiography variables, the TAPSE\/SPAP ratio demonstrated the strongest correlation with V\n              <jats:sc>o<\/jats:sc>\n              <jats:sub>2<\/jats:sub>\n              peak (\n              <jats:italic>r<\/jats:italic>\n              =0.475), VE\/V\n              <jats:sc>co<\/jats:sc>\n              <jats:sub>2<\/jats:sub>\n              (\n              <jats:italic>r<\/jats:italic>\n              =\u22120.585), and workload (\n              <jats:italic>r<\/jats:italic>\n              =0.476) during cardiopulmonary exercise testing (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05 all). Multivariate predictors affecting exercise ventricular-arterial coupling after CRT included metrics of residual exercise mitral regurgitation and systolic and diastolic left ventricular function.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Chronic CRT beneficially influences pulmonary pressures and right ventricular-arterial coupling during exercise, which strongly relates to functional status. These findings are mechanistically linked to reverse remodeling with improved interventricular dependence and reduction in exercise mitral regurgitation.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.118.007813","type":"journal-article","created":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T21:07:55Z","timestamp":1537218475000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Effect of Cardiac Resynchronization Therapy on Exercise-Induced Pulmonary Hypertension and Right Ventricular-Arterial Coupling"],"prefix":"10.1161","volume":"11","author":[{"given":"Pieter","family":"Martens","sequence":"first","affiliation":[{"name":"Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.M., F.H.V., P.B.B., D.V., P.V., M.D., W.M.)."},{"name":"Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium. (P.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik H.","family":"Verbrugge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe B.","family":"Bertrand","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.M., F.H.V., P.B.B., D.V., P.V., M.D., W.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Verhaert","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.M., F.H.V., P.B.B., D.V., P.V., M.D., W.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"Vandervoort","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.M., F.H.V., P.B.B., D.V., P.V., M.D., W.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Dupont","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.M., F.H.V., P.B.B., D.V., P.V., M.D., W.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.H. Wilson","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (W.H.W.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Janssens","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Leuven (UZ Leuven), Belgium (S.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfried","family":"Mullens","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.M., F.H.V., P.B.B., D.V., P.V., M.D., W.M.)."},{"name":"Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium. (W.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032423"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa050496"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.08.027"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0906431"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009540"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.955039"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.04.042"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.112.968511"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-2065"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.112.000127"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.02.049"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2010.09.002"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.01.051"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.08.012"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.022082"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht150"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-311423"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eus222"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2017.03.001"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2017.04.021"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jev014"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.4.1313"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2015.06.018"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jew096"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000087599.49332.05"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm126"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.025260"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00258.2013"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.000667"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2016.12.024"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.051540"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0033-0620(98)80049-2"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.07.087"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2006.119719"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jet092"}],"container-title":["Circulation: Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCIMAGING.118.007813","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T02:23:45Z","timestamp":1715567025000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCIMAGING.118.007813"}},"subtitle":["A Cardiopulmonary Exercise Testing Imaging Evaluation"],"short-title":[],"issued":{"date-parts":[[2018,9]]},"references-count":36,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2018,9]]}},"alternative-id":["10.1161\/CIRCIMAGING.118.007813"],"URL":"https:\/\/doi.org\/10.1161\/circimaging.118.007813","relation":{},"ISSN":["1941-9651","1942-0080"],"issn-type":[{"value":"1941-9651","type":"print"},{"value":"1942-0080","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9]]},"assertion":[{"value":"2018-03-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-07-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-09-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e007813"}}