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Pulmonary vascular disease & thromboembolismCohort study

Exercise Stress Echocardiography of the Right Ventricle and Pulmonary Circulation

J Am Coll CardiolPublished

  • Prospective multicentre cohort study
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Authors' conclusion

Exercise echocardiography of the pulmonary circulation and the right ventricle discloses prognostically relevant differences between healthy subjects, athletes, high-altitude residents, and patients with various cardio-respiratory conditions.

Study context

Population
Healthy subjects, athletes, high-altitude residents and patients with various cardio-respiratory conditions undergoing resting and exercise echocardiography on a semirecumbent cycle ergometer
Participants
2,228 subjects
Exposure
RV and pulmonary circulation response to exercise across healthy subjects, athletes, high-altitude residents and patient categories
  • Healthy controlsn = 375reference
  • Athletesn = 40
  • Cardiovascular risk factorsn = 516
  • Pulmonary arterial hypertensionn = 17
  • Connective tissue diseasesn = 872
  • Left-sided heart diseasen = 113
  • Lung diseasen = 30
  • High altituden = 265

Main finding

As reported in the abstract

Normal limits (5th–95th percentile) of exercise RV–pulmonary circulation indices and predictors of mortality
mPAP–cardiac output slope, 5th–95th percentile in healthy subjects without CV risk factors; increased in all patient categories and high-altitude residents
0.2 to 3.5 mm Hg.min/L
TAPSE/sPAP ratio at rest, 5th–95th percentile; decreased in all disease categories and high-altitude residents
0.7 to 2.0 mm/mm Hg
TAPSE/sPAP ratio at peak exercise, 5th–95th percentile; decreased in all disease categories and high-altitude residents
0.5 to 1.5 mm/mm Hg
Increased all-cause mortality predicted by resting TAPSE/sPAP
<0.7 mm/mm Hg
Increased all-cause mortality predicted by mPAP–cardiac output
>5 mm Hg.min/L

Observational data: associations, not effects.

Further findings

All-cause mortality (predictors) · follow-up

Increased all-cause mortality predicted by resting TAPSE/systolic PAP
<0.7 mm/mm Hg
Increased all-cause mortality predicted by mean PAP–cardiac output
>5 mm Hg.min/L

Original publication

Exercise Stress Echocardiography of the Right Ventricle and Pulmonary Circulation. J Am Coll Cardiol. Published 21 November 2023. doi:10.1016/j.jacc.2023.09.807
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Summarised from the published abstract; every number is checked against it