{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:36:51Z","timestamp":1759797411202,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006769","name":"Russian Science Foundation","doi-asserted-by":"publisher","award":["23-15-00318"],"award-info":[{"award-number":["23-15-00318"]}],"id":[{"id":"10.13039\/501100006769","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Non-invasive diagnostic tools for the assessment of pulmonary arterial hypertension (PAH) are currently being intensively studied. Positron emission tomography (PET)\/computed tomography (CT) with [18F]-fluorodeoxyglucose ([18F]-FDG) and [13N]-ammonia is the gold standard for assessing myocardial metabolism and perfusion. The relationship between right ventricle (RV) myocardial metabolism and perfusion and cardiopulmonary exercise testing (CPET) has not been studied. Objective: to evaluate correlations between the CPET parameters and RV perfusion and metabolism in IPAH patients. Methods: The study comprised 34 IPAH patients (34.2 \u00b1 8.9 years, 4 males, 6 prevalent). Myocardial metabolism and perfusion were assessed using PET\/CT with [18F]-FDG and [13N]-ammonia, respectively. CPET, cardiac MRI and invasive hemodynamics were also evaluated. Results: Significant negative correlations were registered between [18F]-FDG and [13N]-ammonia uptake by the RV (SUVmax RV\/LV) and the oxygen consumption, oxygen pulse and positive correlation with the ratio of minute ventilation to carbon dioxide production. The low-risk IPAH patients significantly differed from the intermediate-to-high-risk group in CPET indices and in SUVmax RV\/LV metabolism and SUVmax RV\/LV perfusion parameters. No reliable differences in CPET indices and [18F]-FDG and [13N]-ammonia uptake by the RV were registered between intermediate- and high-risk patients. Conclusions: CPET is a reliable non-invasive diagnostic tool that could distinguish low-risk young IPAH patients without comorbidities from those at intermediate-to-high risk. Significant correlations between CPET parameters and RV myocardial metabolism and perfusion indices, MRI, and invasive hemodynamics confirm the high diagnostic value for CPET.<\/jats:p>","DOI":"10.3390\/diagnostics15192523","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T11:42:49Z","timestamp":1759750969000},"page":"2523","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Right Ventricular Myocardial Metabolism and Cardiorespiratory Testing in Patients with Idiopathic Pulmonary Arterial Hypertension"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6954-7096","authenticated-orcid":false,"given":"Natalia","family":"Goncharova","sequence":"first","affiliation":[{"name":"Almazov National Medical Research Center, Ministry of Health of Russia, Akkuratova Street 2, Saint Petersburg 197341, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aelita","family":"Berezina","sequence":"additional","affiliation":[{"name":"Almazov National Medical Research Center, Ministry of Health of Russia, Akkuratova Street 2, Saint Petersburg 197341, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daria","family":"Ryzhkova","sequence":"additional","affiliation":[{"name":"Almazov National Medical Research Center, Ministry of Health of Russia, Akkuratova Street 2, Saint Petersburg 197341, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irina","family":"Zlobina","sequence":"additional","affiliation":[{"name":"Almazov National Medical Research Center, Ministry of Health of Russia, Akkuratova Street 2, Saint Petersburg 197341, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirill","family":"Lapshin","sequence":"additional","affiliation":[{"name":"Almazov National Medical Research Center, Ministry of Health of Russia, Akkuratova Street 2, Saint Petersburg 197341, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anton","family":"Ryzhkov","sequence":"additional","affiliation":[{"name":"Almazov National Medical Research Center, Ministry of Health of Russia, Akkuratova Street 2, Saint Petersburg 197341, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aryana","family":"Malanova","sequence":"additional","affiliation":[{"name":"Almazov National Medical Research Center, Ministry of Health of Russia, Akkuratova Street 2, Saint Petersburg 197341, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizaveta","family":"Korobchenko-Andreeva","sequence":"additional","affiliation":[{"name":"Almazov National Medical Research Center, Ministry of Health of Russia, Akkuratova Street 2, Saint Petersburg 197341, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga","family":"Moiseeva","sequence":"additional","affiliation":[{"name":"Almazov National Medical Research Center, Ministry of Health of Russia, Akkuratova Street 2, Saint Petersburg 197341, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.21037\/cdt-20-450","article-title":"Right ventricular dysfunction and long-term risk of death","volume":"10","author":"Sanders","year":"2020","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.yexcr.2017.03.052","article-title":"The role of cardiac energy metabolism in cardiac hypertrophy and failure","volume":"360","author":"Tuomainen","year":"2017","journal-title":"Exp. Cell Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.recesp.2024.05.017","article-title":"Right ventricular dysfunction: Pathophysiology; experimental models; evaluation; treatment","volume":"77","author":"Real","year":"2024","journal-title":"Rev. Esp. Cardiol. (Engl. Ed.)"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.21037\/cdt-20-404","article-title":"Molecular mechanisms of right ventricular dysfunction in pulmonary arterial hypertension: Focus on the coronary vasculature, sex hormones, and glucose\/lipid metabolism","volume":"10","author":"Agrawal","year":"2020","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s00395-024-01041-5","article-title":"Metabolic changes contribute to maladaptive right ventricular hypertrophy in pulmonary hypertension beyond pressure overload: An integrative imaging and omics investigation","volume":"119","author":"Jorge","year":"2024","journal-title":"Basic Res. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e12363","DOI":"10.1002\/pul2.12363","article-title":"(18)F-fluorodeoxyglucose uptake by positron emission tomography in patients with IPAH and CTEPH","volume":"14","author":"Sumer","year":"2024","journal-title":"Pulm. Circ."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e70042","DOI":"10.1002\/pul2.70042","article-title":"PET\/CT Imaging of the Right Heart Perfusion and Glucose Metabolism Depending on a Risk Status in Patients with Idiopathic Pulmonary Arterial Hypertension","volume":"15","author":"Goncharova","year":"2025","journal-title":"Pulm Circ."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"170039","DOI":"10.1183\/16000617.0039-2017","article-title":"Exertional dyspnoea in pulmonary arterial hypertension","volume":"26","author":"Dumitrescu","year":"2017","journal-title":"Eur. Respir. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Pezzuto, B., and Agostoni, P. (2023). The Current Role of Cardiopulmonary Exercise Test in the Diagnosis and Management of Pulmonary Hypertension. J. Clin. Med., 12.","DOI":"10.3390\/jcm12175465"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2045894020950187","article-title":"Dynamic right ventricular function response to incremental exercise in pulmonary hypertension","volume":"10","author":"Singh","year":"2020","journal-title":"Pulm. Circ."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.healun.2019.12.012","article-title":"Clinical implications of idiopathic pulmonary arterial hypertension phenotypes defined by cluster analysis","volume":"39","author":"Badagliacca","year":"2020","journal-title":"J. Heart Lung Transplant."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e12342","DOI":"10.1002\/pul2.12342","article-title":"Simplified risk stratification based on cardiopulmonary exercise test: A Spanish two-center experience","volume":"14","year":"2024","journal-title":"Pulm. Circ."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4683","DOI":"10.15829\/1560-4071-2021-4683","article-title":"2020 Clinical practice guidelines for Pulmonary hypertension, including chronic thromboembolic pulmonary hypertension","volume":"26","author":"Avdeev","year":"2021","journal-title":"Russ. J. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3618","DOI":"10.1093\/eurheartj\/ehac237","article-title":"2022 ESC\/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension","volume":"43","author":"Humbert","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"6161","DOI":"10.15829\/1560-4071-2024-6161","article-title":"2024 Clinical practice guidelines for Pulmonary hypertension, including chronic thromboembolic pulmonary hypertension","volume":"29","author":"Avdeev","year":"2024","journal-title":"Russ. J. Cardiol."},{"key":"ref_16","first-page":"E214","article-title":"Glucose clamp technique: A method for quantifying insulin secretion and resistance","volume":"273","author":"DeFronzo","year":"1979","journal-title":"Am J Physiol"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Langleben, D., Orfanos, S.E., Fox, B.D., Messas, N., Giovinazzo, M., and Catravas, J.D. (2022). The Paradox of Pulmonary Vascular Resistance: Restoration of Pulmonary Capillary Recruitment as a Sine Qua Non for True Therapeutic Success in Pulmonary Arterial Hypertension. J. Clin. Med., 11.","DOI":"10.3390\/jcm11154568"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.jacc.2016.10.047","article-title":"The Relationship Between the Right Ventricle and its Load in Pulmonary Hypertension","volume":"69","author":"Noordegraaf","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2045894020957223","article-title":"Right ventriculo-pulmonary arterial uncoupling and poor outcomes in pulmonary arterial hypertension","volume":"10","author":"Nakaya","year":"2020","journal-title":"Pulm. Circ."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e12044","DOI":"10.1002\/pul2.12044","article-title":"Role of cardiopulmonary exercise test in the prediction of hemodynamic impairment in patients with pulmonary arterial hypertension","volume":"12","author":"Pezzuto","year":"2022","journal-title":"Pulm. Circ."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.hfc.2022.08.015","article-title":"Cardiopulmonary Exercise Testing in Pulmonary Arterial Hypertension","volume":"19","author":"Sherman","year":"2023","journal-title":"Heart Fail. Clin."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5540","DOI":"10.15829\/15604071-2023-5540","article-title":"Cardiac magnetic resonance imaging in mortality risk stratification of patients with pulmonary hypertension","volume":"28","author":"Goncharova","year":"2023","journal-title":"Russ. J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1002\/ehf2.13839","article-title":"Pressure-based estimation of right ventricular ejection fraction","volume":"9","author":"Heerd","year":"2022","journal-title":"ESC Heart Fail."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2202225","DOI":"10.1183\/13993003.02225-2022","article-title":"Establishing minimally important differences for cardiac MRI end-points in pulmonary arterial hypertension","volume":"62","author":"Alabed","year":"2023","journal-title":"Eur. Respir. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1093\/ehjci\/jev136","article-title":"Shifts in myocardial fatty acid and glucose metabolism in pulmonary arterial hypertension: A potential mechanism for a maladaptive right ventricular response","volume":"17","author":"Ohira","year":"2016","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s00395-023-01018-w","article-title":"The role of glycolytic metabolic pathways in cardiovascular disease and potential therapeutic approaches","volume":"118","author":"Chen","year":"2023","journal-title":"Basic Res. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"PA588","DOI":"10.1183\/13993003.congress-2021.PA588","article-title":"18-FDG uptake on PET-CT and metabolism in pulmonary arterial hypertension","volume":"58","author":"Trujillo","year":"2021","journal-title":"Pulm. Hypertens."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13550-023-00971-w","article-title":"The impact of specific pulmonary arterial hypertension therapy on cardiac fluorodeoxyglucose distribution in PET\/MRI hybrid imaging-follow-up study","volume":"13","author":"Kazimierczyk","year":"2023","journal-title":"EJNMMI Res."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Song, Y., Jia, H., Ma, Q., Zhang, L., Lai, X., and Wang, Y. (2024). The causes of pulmonary hypertension and the benefits of aerobic exercise for pulmonary hypertension from an integrated perspective. Front. Physiol., 15.","DOI":"10.3389\/fphys.2024.1461519"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e20240240","DOI":"10.36416\/1806-3756\/e20240240","article-title":"The role of the exercise physiology laboratory in disease management: Pulmonary arterial hypertension","volume":"50","author":"Ferreira","year":"2024","journal-title":"J. Bras. Pneumol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2401325","DOI":"10.1183\/13993003.01325-2024","article-title":"Treatment algorithm for pulmonary arterial hypertension","volume":"64","author":"Chin","year":"2024","journal-title":"Eur. Respir. J."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/19\/2523\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T11:54:08Z","timestamp":1759751648000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/19\/2523"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,6]]},"references-count":31,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["diagnostics15192523"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15192523","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,6]]}}}