Echocardiographic assessment of right ventricular contractile reserve in healthy subjects

D′Alto, Michele; Pavelescu, Adriana; Argiento, Paola; Romeo, Emanuele; Correra, Anna; Marco, Giovanni Maria Di; D’Andrea, Antonello; Sarubbi, Berardo; Russo, Maria Giovanna; Naeije, Robert

doi:10.1111/echo.13396

Cited by 42 publications

(31 citation statements)

References 25 publications

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“…The limits of normal of the indices of RV function during exercise are less well known. The increases in sPAP/ESA and decreases in TAPSE/sPAP found with cycling in the present study agree with previously reported values [7,14]. Large increases in TAPSE, S (tricuspid annulus tissue Doppler velocity), FAC and sPAP/ESA during cycle ergometry again point at this purely dynamic maximum exercise test as being preferable for exercise stress testing of the RV.…”

supporting

confidence: 92%

Resistive or dynamic exercise stress testing of the pulmonary circulation and the right heart

et al. 2017

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There has been recent revival of interest in exercise stress testing of the pulmonary circulation and the right ventricle (RV) for the differential diagnosis of dyspnoea or latent pre-or post-capillary pulmonary hypertension [1-3]. However, guidelines remain cautious because of persistent uncertainties about protocols and the limits of normal [4]. In fact, exercise protocols still vary, with either cycling [3, 6-8], weight lifting [5, 6] or even handgrip [9] modalities, with invasive [3, 5-7, 9] or non-invasive [7, 8, 10] measurements either during [3, 6-10] or after [5] the exercise stress. Furthermore, pulmonary artery pressure (PAP) has been reported either alone [5, 8] or as a function of either cardiac output (CO) [1-3, 7, 10], workload [7, 11] or oxygen uptake (V′O 2) [12]. In the meantime, flow-corrected PAP during exercise emerges as the measurement of choice for pulmonary vascular function [1-3], and body position may not matter provided a sufficient number of exercise pressure-flow coordinates is generated to smoothen out higher baseline pulmonary vascular resistance (PVR) in the upright position [10], but there remains uncertainty about the most relevant measurements of RV function [7, 13, 14]. Although there is a rationale in favour of incremental dynamic exercise, there is currently no consensus about the optimal exercise modality. We therefore compared the cardiovascular and gas exchange effects of resistive (handgrip), mixed resistive/dynamic (weight lifting) or dynamic (cycling) exercise on the pulmonary circulation and the RV in healthy volunteers. A total of 26 healthy young volunteers-14 women and 12 men, height 170±10 cm, weight 66±12 kg, age 22±3 yearsgave informed consent to the study, which was approved by the Ethical Committee of Erasme University Hospital. All of them prospectively performed, in a random order, a handgrip at 40% of maximum voluntary contraction for 3 min or arm adduction lifting of dumbbells (2.5 kg for women and 5 kg for men) for 3 min, followed by cycling with the workload increased every 2 min (by 20 W in women and 30 W in men) until exhaustion. An echocardiography of the RV and the pulmonary circulation, as well as measurements of blood pressure (BP), heart rate (HR), ventilation (V′E), V′O 2 and carbon dioxide output (V′CO 2), were performed at baseline and during the last minute of the handgrip and weight lifting and of each workload during cycle ergometry. The subjects waited between each of these exercise challenges until they felt rested and HR had returned to baseline. The exercise tests were performed in a semi-recumbent position in a dedicated echocardiography chair (Ergoselect 1200, Ergoline GmbH, Bitz, Germany) as previously reported [10]. Handgrip was performed using a dynamometer (Jamar Hydraulic hand dynamometer, Lafayette Instrument, Lafayette, IN, USA). Ventilation and gas exchange were measured using a metabolic system (CPX, Medgraphics, St Paul, MN, USA). Doppler echocardiography was performed with a portable ultrasound system (CX50 CompactXtreme Ultr...

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confidence: 92%

Resistive or dynamic exercise stress testing of the pulmonary circulation and the right heart

et al. 2017

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“…Recently, D'Alto et al demonstrated that echocardiographic RV systolic function indices (tricuspid annular plane systolic excursion (TAPSE), S′, and TAPSE/PAP) correlate with maximal workload in healthy subjects. This finding illustrates that a higher RV contractility reserve, defined as the difference between peak exercise and rest, is an advantage to reach high exercise levels and suggests a potential role of the RV in exercise capacity limitation [13].…”

Section: Right Ventriclementioning

confidence: 71%

“…However, RV anatomical and physiological properties are maybe not designed to face dramatical afterload increase at high levels of exercise. As compared to the left ventricle (LV), load increases are greater for the RV during exercise [12], and its contractile reserve may become insufficient for adequate blood supply to peripheral demand [12,13]. Relative to the LV, the greater load that the RV faces during exercise is dominantly attributed to a larger exercise-induced increase in pulmonary artery pressure (PAP) relative to systemic vascular pressure [3].…”

Section: Right Ventriclementioning

confidence: 99%

Pulmonary Vascular Reserve and Aerobic Exercise Capacity

Faoro¹,

Forton²

2019

Interventional Pulmonology and Pulmonary Hypertension - Updates on Specific Topics [Working Title]

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Pulmonary circulation has long been known to have specific proprieties of recruitment and distention to keep the hemodynamic pressure low even when facing very high blood flow. Aerobic exercise especially at high intensity has the particularity to increase considerably the cardiac output. The ability of the pulmonary circulation to face high blood flow with maintaining low pressures is considered as the pulmonary vascular reserve. Furthermore, high pulmonary vascular reserve has been shown to be characterized by low pulmonary vascular resistance, high pulmonary vascular distensibility, high pulmonary capillary volume, and high lung diffusing capacity allowing for lower ventilation at a same metabolic cost. The pulmonary vascular reserve thus reflects the capacity of the pulmonary circulation, including the capillary network, to adapt to high exercise levels. Interestingly, a high pulmonary vascular reserve is an advantage as it is associated with a superior aerobic exercise capacity (VO 2 max). This observation strongly suggests that exercise capacity is modulated by the functional state of the pulmonary circulation. However, why or when pulmonary vascular reserve may be related to a higher aerobic exercise capacity remains incompletely understood. The present chapter will discuss the role of each component of the pulmonary vascular reserve during exercise and develop the factors able to influence the pulmonary vascular reserve in heathy individuals.

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“…They found a blunted increase in cardiac index response to exercise which is a crucial determinant of exercise capacity and clinical outcome in precapillary PH. In a study performed in healthy subjects using ESE, RV contractile reserve (∆PASP, ∆SV, ∆S′, ∆TAPSE/PASP) was associated with maximum exercise capacity (defined as the maximal workload) . In a small‐scale study by Sharma et al, RV contractile reserve (∆S′ and ∆SV) was shown to correlate with exercise capacity (assessed by CPET) of patients with pulmonary arterial hypertension.…”

Section: Discussionmentioning

confidence: 96%

“…18,19 Peak VO 2 is the most widely used parameter of exercise capacity and provides prognostic information. 20 25 In a small-scale study by Sharma et al, 26 RV contractile reserve (∆S′ and ∆SV) was shown to correlate with exercise capacity (assessed by CPET) of patients with pulmonary arterial hypertension.…”

Section: Discussionmentioning

confidence: 98%

Influence of impaired right ventricular contractile reserve on exercise capacity in patients with precapillary pulmonary hypertension: A study with exercise stress echocardiography

Guo

Yang

et al. 2019

Echocardiography

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Objectives Right ventricular (RV) contractile reserve reflects the ability of RV to accommodate the increased afterload and may play an essential role in the evaluation of precapillary pulmonary hypertension (PH). This study aimed to assess RV contractile reserve based on exercise stress echocardiography (ESE) and to determine the echocardiographic determinants of exercise capacity in patients with precapillary PH. Methods A total of 31 patients with precapillary PH and 15 age‐ and sex‐matched healthy control subjects were prospectively recruited. All subjects underwent ESE to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. Patients with precapillary PH also underwent cardiopulmonary exercise test (CPET), and data pertaining to peak oxygen uptake (peak VO2) and minute ventilation/carbon dioxide production (VE/VCO2) were collected. Results Right ventricular contractile reserve including change in tricuspid annular plane systolic excursion (∆TAPSE), change in RV fractional area change (∆RVFAC), and change in Doppler‐derived tricuspid lateral annular peak systolic velocity (∆S′) was significantly depressed in precapillary PH patients compared with control subjects (P < 0.05). Parameters of RV function and RV contractile reserve were markedly associated with maximal exercise capacity (P < 0.05). ∆RVFAC was an independent predictor of peak VO2 (r2 = 0.601, P < 0.05). Conclusions Assessment of RV contractile reserve facilitates identification of subclinical dysfunction and evaluation of clinical status and severity of precapillary PH. ESE as a noninvasive method may provide a comprehensive clinical assessment and facilitate therapeutic decision‐making for these patients.

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Echocardiographic assessment of right ventricular contractile reserve in healthy subjects

Abstract: Our results provide age- and sex-related limits of normal for RV contractile reserve as assessed by exercise stress echocardiography and demonstrate that RV systolic function indices (PASP, TAPSE, S', and TAPSE/PASP) correlate with maximum exercise capacity.

Cited by 42 publications

References 25 publications

Resistive or dynamic exercise stress testing of the pulmonary circulation and the right heart

Resistive or dynamic exercise stress testing of the pulmonary circulation and the right heart

Pulmonary Vascular Reserve and Aerobic Exercise Capacity

Influence of impaired right ventricular contractile reserve on exercise capacity in patients with precapillary pulmonary hypertension: A study with exercise stress echocardiography

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