The effect of left ventricular dysfunction on right ventricle ejection fraction during exercise in heart failure patients: Implications in functional capacity and blood pressure response

Background: The aim of this study was to assess the effect of left ventricular dysfunction on right ventricular ejection fraction during exercise in heart failure patients and its implications in functional capacity and blood pressure response. Methods: In a cross-sectional study 65 patients with heart failure were included. Left and right ventricular ejection fractions were evaluated by radio-isotopic ventriculography. All subjects underwent an exercise treadmill test (Bruce modified protocol). Systolic and diastolic blood pressures were also recorded. Results: From the total population, 38 (58.46%) showed a significant increase (≥ 5%) in left ventricular ejection fraction (LVEF) and 27 (41.5%) showed a significant decrease in LVEF (≥ 5%) after the stress test. Patients with a significant reduction in LVEF during stress had lower exercise tolerance (4.1 ± 2.5 vs. 6.1 ± 2.5 METs, p = 0.009) compared to those who showed an increase in LVEF. Diastolic blood pressure was higher at rest among those who had a reduced LVEF during stress (83 ± 12.2 vs. 72.6 ± 12.2 mm Hg, p = 0.035) and during exercise (95 ± 31.3 vs. 76.9 ± 31.3 mm Hg, p = 0.057), as well as mean arterial pressure in the same group (97.1 ± 11.6 mm Hg, p = 0.05). In addition, this group decrease of –8.8 ± 51.6% in the right ventricular ejection fraction after exercise compared to an increase of 27.3 ± ± 49.1% (p = 0.007) among the patients with an increase in LVEF. Conclusions: Biventricular systolic dysfunction during exercise is associated with higher rest and stress blood pressure and worse functional capacity.