
In pulmonary arterial hypertension (PAH), poor cardiac output reserve during exercise is linked to right ventricular (RV) stiffness and impaired interventricular dependence. A study analyzing pressure-volume loops in 41 PAH patients found that those with low cardiac index reserve during exercise had higher RV stiffness, right-sided pressures, and lower left ventricular filling. This suggests that RV stiffness and afterload are key factors in poor exercise tolerance in PAH.
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