Heart and Vessels

, Volume 34, Issue 3, pp 385–392 | Cite as

Right ventricular dysfunction is associated with exercise intolerance and poor prognosis in ischemic heart disease

  • Miyu TajimaEmail author
  • Atsuko Nakayama
  • Reina Uewaki
  • Keitaro Mahara
  • Mitsuaki Isobe
  • Masatoshi Nagayama
Original Article


Right ventricular (RV) function is a prognostic factor in ischemic heart disease (IHD) patients, although its correlations with exercise capacity and cardiac rehabilitation (CR) efficacy are unknown. We aimed to clarify how RV function was associated with exercise tolerance and efficacy of phase II CR in IHD patients. We retrospectively analyzed 301 consecutive IHD patients who underwent phase II CR. We defined RV dysfunction using a combination of RV fractional area change < 35%, tricuspid annular plane systolic excursion < 1.6 cm, and systolic velocity < 10 cm/s. Exercise capacity was assessed using cardiopulmonary testing. The relation between RV function and exercise capacity was analyzed. The all-cause death and major adverse cardiac events (MACE) were evaluated by survival curve. The RV dysfunction group (n = 121) showed impaired left ventricular (LV) systolic and diastolic function before CR contrary to the normal RV function group (n = 180). The presence of RV dysfunction significantly reduced %AT by 4% and %Peak\(\dot{V}{\text{O}}_{ 2}\) by 9% before CR, but increases the degree of improvement in %Peak\(\dot{V}{\text{O}}_{ 2}\) with CR, independent of LV systolic and diastolic function. Univariate analysis demonstrated that previous coronary artery bypass grafting (CABG) was negatively associated with all-cause deaths and MACE. Adjusted for previous CABG, poor prognosis correlated with coexisting LV and RV dysfunction (hazard ratio [HR] 3.91, 95% confidence interval [CI] 1.13–13.53, P = 0.03) and RV dysfunction alone (HR 3.08, 95% CI 1.01–9.37, P = 0.05). In IHD patients, RV dysfunction is associated with exercise intolerance before CR and increased MACE risk, independent of LV function. The CR was effective in patients with RV dysfunction.


Myocardial ischemia Coronary artery disease Right ventricular function Left ventricular function Exercise tolerance Cardiac rehabilitation 



This study was supported by a research grant from the Sakakibara Heart Institute.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest to declare.


  1. 1.
    Bleasdale RA, Frenneaux MP (2002) Prognostic importance of right ventricular dysfunction. Heart 88:323–324CrossRefGoogle Scholar
  2. 2.
    Sabe MA, Sabe SA, Kusunose K, Flamm SD, Griffin BP, Kwon DH (2016) Predictors and prognostic significance of right ventricular ejection fraction in patients with ischemic cardiomyopathy. Circulation 134:656–665CrossRefGoogle Scholar
  3. 3.
    Anavekar NS, Skali H, Bourgoun M, Ghali JK, Kober L, Maggioni AP, McMurray JJ, Velazquez E, Califf R, Pfeffer MA, Solomon SD (2008) Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study). Am J Cardiol 101:607–612CrossRefGoogle Scholar
  4. 4.
    Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713CrossRefGoogle Scholar
  5. 5.
    Baker BJ, Wilen MM, Boyd CM, Dinh H, Franciosa JA (1984) Relation of right ventricular ejection fraction to exercise capacity in chronic left ventricular failure. Am J Cardiol 54:596–599CrossRefGoogle Scholar
  6. 6.
    Hedman A, Alam M, Zuber E, Nordlander R, Samad BA (2004) Decreased right ventricular function after coronary artery bypass grafting and its relation to exercise capacity: a tricuspid annular motion-based study. J Am Soc Echocardiogr 17:126–131CrossRefGoogle Scholar
  7. 7.
    Mezzani A, Agostoni P, Cohen-Solal A, Corrà U, Jegier A, Kouidi E, Mazic S, Meurin P, Piepoli M, Simon A, Laethem CV, Vanhees L (2009) Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the Exercise Physiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 16:249–267CrossRefGoogle Scholar
  8. 8.
    American Thoracic Society; American College of Chest Physicians (2003) ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 167:211–277CrossRefGoogle Scholar
  9. 9.
    Itoh H, Ajisaka R, Koike A, Makita S, Omiya K, Kato Y, Adachi H, Nagayama M, Maeda T, Tajima A, Harada N, Taniguchi K, Committee on Exercise Prescription for Patients (CEPP) Members (2013) Heart rate and blood pressure response to ramp exercise and exercise capacity in relation to age, gender, and mode of exercise in a healthy population. J Cardiol 61:71–78CrossRefGoogle Scholar
  10. 10.
    JCS Joint Working Group (2014) Guidelines for rehabilitation in patients with cardiovascular disease (JCS 2012). Circ J 78:2022–2093CrossRefGoogle Scholar
  11. 11.
    D’Alto M, Pavelescu A, Argiento P, Romeo E, Correra A, Di Marco GM, D’Andrea A, Sarubbi B, Russo MG, Naeije R (2017) Echocardiographic assessment of right ventricular contractile reserve in healthy subjects. Echocardiography 34:61–68CrossRefGoogle Scholar
  12. 12.
    Ghio S, Guazzi M, Scardovi AB, Klersy C, Clemenza F, Carluccio E, Temporelli PL, Rossi A, Faggiano P, Traversi E, Vriz O, Dini FL, All investigators (2017) Different correlates but similar prognostic implications for right ventricular dysfunction in heart failure patients with reduced or preserved ejection fraction. Eur J Heart Fail 19:873–879CrossRefGoogle Scholar
  13. 13.
    Rubis P, Podolec P, Kopec G, Olszowska M, Tracz W (2010) The dynamic assessment of right-ventricular function and its relation to exercise capacity in heart failure. Eur J Heart Fail 12:260–267CrossRefGoogle Scholar
  14. 14.
    Kim J, Di Franco A, Seoane T, Srinivasan A, Kampaktsis PN, Geevarghese A, Goldburg SR, Khan SA, Szulc M, Ratcliffe MB, Levine RA, Morgan AE, Maddula P, Rozenstrauch M, Shah T, Devereux RB, Weinsaft JW (2016) Right ventricular dysfunction impairs effort tolerance independent of left ventricular function among patients undergoing exercise stress myocardial perfusion imaging. Circ Cardiovasc Imaging 9:e005115Google Scholar
  15. 15.
    Engström AE, Vis MM, Bouma BJ, van den Brink RB, Baan J Jr, Claessen BE, Kikkert WJ, Sjauw KD, Meuwissen M, Koch KT, de Winter RJ, Tijssen JG, Piek JJ, Henriques JP (2010) Right ventricular dysfunction is an independent predictor for mortality in ST-elevation myocardial infarction patients presenting with cardiogenic shock on admission. Eur J Heart Fail 12:276–282CrossRefGoogle Scholar
  16. 16.
    Alam M, Hedman A, Nordlander R, Samad B (2003) Right ventricular function before and after an uncomplicated coronary artery bypass graft as assessed by pulsed wave Doppler tissue imaging of the tricuspid annulus. Am Heart J 146:520–526CrossRefGoogle Scholar
  17. 17.
    Pegg TJ, Selvanayagam JB, Karamitsos TD, Arnold RJ, Francis JM, Neubauer S, Taggart DP (2008) Effects of off-pump versus on-pump coronary artery bypass grafting on early and late right ventricular function. Circulation 117:2202–2210CrossRefGoogle Scholar
  18. 18.
    Jürs A, Pedersen LR, Olsen RH, Snoer M, Chabanova E, Haugaard SB, Prescott E (2015) Coronary microvascular function, insulin sensitivity and body composition in predicting exercise capacity in overweight patients with coronary artery disease. BMC Cardiovasc Disord 15:159CrossRefGoogle Scholar
  19. 19.
    Tadic M, Cuspidi C, Backovic S, Kleut M, Ivanovic B, Scepanovic R, Iracek O, Celic V (2014) High-normal blood pressure, functional capacity and left heart mechanics: is there any connection? Blood Press 23:315–321CrossRefGoogle Scholar
  20. 20.
    Kim C, Choi HE, Lim YJ (2016) The effect of cardiac rehabilitation exercise training on cardiopulmonary function in ischemic cardiomyopathy with reduced left ventricular ejection fraction. Ann Rehabil Med 40:647–656CrossRefGoogle Scholar
  21. 21.
    Lim HS, Theodosiou M (2014) Exercise ventilatory parameters for the diagnosis of reactive pulmonary hypertension in patients with heart failure. J Card Fail 20:650–657CrossRefGoogle Scholar
  22. 22.
    Mimura J, Yuasa F, Yuyama R, Kawamura A, Iwasaki M, Sugiura T, Iwasaka T (2005) The effect of residential exercise training on baroreflex control of heart rate and sympathetic nerve activity in patients with acute myocardial infarction. Chest 127:1108–1115Google Scholar
  23. 23.
    Rolim LC, Sá JR, Chacra AR, Dib SA (2008) Diabetic cardiovascular autonomic neuropathy: risk factors, clinical impact and early diagnosis. Arq Bras Cardiol 90:e24–e2431CrossRefGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Department of Cardiovascular MedicineSakakibara Heart InstituteTokyoJapan
  3. 3.Department of PhysiotherapySakakibara Heart InstituteTokyoJapan

Personalised recommendations