Exercise stress echocardiography of the pulmonary circulation and right ventricular-arterial coupling in healthy adolescents

Forton, Kevin; Motoji, Yoshiki; Caravita, Sergio; Faoro, Vitalie; Naeije, Robert

doi:10.1093/ehjci/jeaa085

Cited by 19 publications

(11 citation statements)

References 35 publications

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“…Bossone et al showed that athletes have higher TRV compared with healthy control subjects both at rest and during exercise related to the higher SV and CO reached [35]. Interestingly, Forton et al, in a cohort of adolescents and adults who underwent EDE, found that pulmonary vascular distensibility coefficient α was inversely related to age at rest as well as during exercise [36]. These results confirm the age-related increase in pulmonary artery pressure (positive correlation) [37][38][39].…”

Section: Discussionmentioning

confidence: 78%

Right Heart Pulmonary Circulation Unit Response to Exercise in Patients with Controlled Systemic Arterial Hypertension: Insights from the RIGHT Heart International NETwork (RIGHT-NET)

Vriz

Palatini

Rudski

et al. 2022

JCM

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Background. Systemic arterial hypertension (HTN) is the main risk factor for the development of heart failure with preserved ejection fraction (HFpEF). The aim of the study was was to assess the trends in PASP, E/E’ and TAPSE during exercise Doppler echocardiography (EDE) in hypertensive (HTN) patients vs. healthy subjects stratified by age. Methods. EDE was performed in 155 hypertensive patients and in 145 healthy subjects (mean age 62 ± 12.0 vs. 54 ± 14.9 years respectively, p < 0.0001). EDE was undertaken on a semi-recumbent cycle ergometer with load increasing by 25 watts every 2 min. Left ventricular (LV) and right ventricular (RV) dimensions, function and hemodynamics were evaluated. Results. Echo-Doppler parameters of LV and RV function were lower, both at rest and at peak exercise in hypertensives, while pulmonary hemodynamics were higher as compared to healthy subjects. The entire cohort was then divided into tertiles of age: at rest, no significant differences were recorded for each age group between hypertensives and normotensives except for E/E’ that was higher in hypertensives. At peak exercise, hypertensives had higher pulmonary artery systolic pressure (PASP) and E/E’ but lower tricuspid annular plane systolic excursion (TAPSE) as age increased, compared to normotensives. Differences in E/E’ and TAPSE between the 2 groups at peak exercise were explained by the interaction between HTN and age even after adjustment for baseline values (p < 0.001 for E/E’, p = 0.011 for TAPSE). At peak exercise, the oldest group of hypertensive patients had a mean E/E’ of 13.0, suggesting a significant increase in LV diastolic pressure combined with increased PASP. Conclusion. Age and HTN have a synergic negative effect on E/E’ and TAPSE at peak exercise in hypertensive subjects.

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Section: Discussionmentioning

confidence: 78%

Right Heart Pulmonary Circulation Unit Response to Exercise in Patients with Controlled Systemic Arterial Hypertension: Insights from the RIGHT Heart International NETwork (RIGHT-NET)

Vriz

Palatini

Rudski

et al. 2022

JCM

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“…In any individual, cardiac adaptations to exercise are influenced by several factors including training mode, intensity, duration and volume [1,3,19,[23][24][25][26]. Cardiac remodeling of the right ventricle in athletes was intensively investigated [6,10,[26][27][28][29][30][31][32] and different echocardiographic approaches were proposed to identify pathological changes [1,3,33]. However, so far, accepted reference values for athletes exist mainly for morphological echocardiographic measurements as highlighted in recent meta-analyses [28,32].…”

Section: Discussionmentioning

confidence: 99%

“…This phenomenon has been named "cardiac fatigue" and encouraged discussions about detrimental effects of prolonged exercise sessions on RV remodeling [9,10,29]. In consequence, as shown for healthy adults during an exercise test, TAPSE/SPAP ratio decreased [27]. Hence, assessment of TAPSE/SPAP should be undertaken under similar conditions.…”

Section: Discussionmentioning

confidence: 99%

Normative values of non-invasively assessed RV function and pulmonary circulation coupling for pre-participation screening derived from 497 male elite athletes

Bauer

Tello

Kraushaar³

et al. 2022

Clin Res Cardiol

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Background Reference values for right ventricular function and pulmonary circulation coupling were recently established for the general population. However, normative values for elite athletes are missing, even though exercise-related right ventricular enlargement is frequent in competitive athletes. Methods We examined 497 healthy male elite athletes (age 26.1 ± 5.2 years) of mixed sports with a standardized transthoracic echocardiographic examination. Tricuspid annular plane excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) were measured. Pulmonary circulation coupling was calculated as TAPSE/SPAP ratio. Two age groups were defined (18–29 years and 30–39 years) and associations of clinical parameters with the TAPSE/SPAP ratio were determined and compared for each group. Results Athletes aged 18–29 (n = 349, 23.8 ± 3.5 years) displayed a significantly lower TAPSE/SPAP ratio (1.23 ± 0.3 vs. 1.31 ± 0.33 mm/mmHg, p = 0.039), TAPSE/SPAP to body surface area (BSA) ratio (0.56 ± 0.14 vs. 0.6 ± 0.16 mm*m2/mmHg, p = 0.017), diastolic blood pressure (75.6 ± 7.9 vs. 78.8 ± 10.7 mmHg, p < 0.001), septal wall thickness (10.2 ± 1.1 vs. 10.7 ± 1.1 mm, p = 0.013) and left atrial volume index (27.5 ± 4.5 vs. 30.8 ± 4.1 ml/m2, p < 0.001), but a higher SPAP (24.2 ± 4.5 vs. 23.2 ± 4.4 mmHg, p = 0.035) compared to athletes aged 30–39 (n = 148, 33.1 ± 3.4 years). TAPSE was not different between the age groups. The TAPSE/SPAP ratio was positively correlated with left ventricular stroke volume (r = 0.133, p = 0.018) and training amount per week (r = 0.154, p = 0.001) and negatively correlated with E/E′ lat. (r = −0.152, p = 0.005). Conclusion The reference values for pulmonary circulation coupling determined in this study could be used to interpret and distinguish physiological from pathological cardiac remodeling in male elite athletes.

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“…Forton and colleagues observed an age‐related decrease of TAPSE/PASP and S′/PASP from adolescence to early adulthood in healthy volunteers. 53 In patients with atrial septal defect (ASD), initial TAPSE/PASP was shown to predict remaining symptoms after ASD closure, along with PVR index. 54 Additionally, TAPSE/PASP significantly improved after ASD closure in symptom‐free patients, but not in patients with residual symptoms.…”

Section: Non‐invasive Surrogates Of Right Ventricular–pulmonary Arter...mentioning

confidence: 99%

“…Echocardiography‐derived RV–PA coupling surrogates also gathered interest in the paediatric field, particularly owing to their non‐invasive nature. Forton and colleagues observed an age‐related decrease of TAPSE/PASP and S′/PASP from adolescence to early adulthood in healthy volunteers 53 . In patients with atrial septal defect (ASD), initial TAPSE/PASP was shown to predict remaining symptoms after ASD closure, along with PVR index 54 .…”

Section: Non‐invasive Surrogates Of Right Ventricular–pulmonary Arter...mentioning

confidence: 99%

Adaptive versus maladaptive right ventricular remodelling

et al. 2022

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Right ventricular (RV) function and its adaptation to increased afterload [RV–pulmonary arterial (PA) coupling] are crucial in various types of pulmonary hypertension, determining symptomatology and outcome. In the course of disease progression and increasing afterload, the right ventricle undergoes adaptive remodelling to maintain right‐sided cardiac output by increasing contractility. Exhaustion of compensatory RV remodelling (RV–PA uncoupling) finally leads to maladaptation and increase of cardiac volumes, resulting in heart failure. The gold‐standard measurement of RV–PA coupling is the ratio of contractility [end‐systolic elastance (Ees)] to afterload [arterial elastance (Ea)] derived from RV pressure–volume loops obtained by conductance catheterization. The optimal Ees/Ea ratio is between 1.5 and 2.0. RV–PA coupling in pulmonary hypertension has considerable reserve; the Ees/Ea threshold at which uncoupling occurs is estimated to be ~0.7. As RV conductance catheterization is invasive, complex, and not widely available, multiple non‐invasive echocardiographic surrogates for Ees/Ea have been investigated. One of the first described and best validated surrogates is the ratio of tricuspid annular plane systolic excursion to estimated pulmonary arterial systolic pressure (TAPSE/PASP), which has shown prognostic relevance in left‐sided heart failure and precapillary pulmonary hypertension. Other RV–PA coupling surrogates have been formed by replacing TAPSE with different echocardiographic measures of RV contractility, such as peak systolic tissue velocity of the lateral tricuspid annulus (S′), RV fractional area change, speckle tracking‐based RV free wall longitudinal strain and global longitudinal strain, and three‐dimensional RV ejection fraction. PASP‐independent surrogates have also been studied, including the ratios S′/RV end‐systolic area index, RV area change/RV end‐systolic area, and stroke volume/end‐systolic volume. Limitations of these non‐invasive surrogates include the influence of severe tricuspid regurgitation (which can cause distortion of longitudinal measurements and underestimation of PASP) and the angle dependence of TAPSE and PASP. Detection of early RV remodelling may require isolated analysis of single components of RV shortening along the radial and anteroposterior axes as well as the longitudinal axis. Multiple non‐invasive methods may need to be applied depending on the level of RV dysfunction. This review explains the mechanisms of RV (mal)adaptation to its load, describes the invasive assessment of RV–PA coupling, and provides an overview of studies of non‐invasive surrogate parameters, highlighting recently published works in this field. Further large‐scale prospective studies including gold‐standard validation are needed, as most studies to date had a retrospective, single‐centre design with a small number of participants, and validation against gold‐standard Ees/Ea was rarely performed.

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Exercise stress echocardiography of the pulmonary circulation and right ventricular-arterial coupling in healthy adolescents

Cited by 19 publications

References 35 publications

Right Heart Pulmonary Circulation Unit Response to Exercise in Patients with Controlled Systemic Arterial Hypertension: Insights from the RIGHT Heart International NETwork (RIGHT-NET)

Right Heart Pulmonary Circulation Unit Response to Exercise in Patients with Controlled Systemic Arterial Hypertension: Insights from the RIGHT Heart International NETwork (RIGHT-NET)

Normative values of non-invasively assessed RV function and pulmonary circulation coupling for pre-participation screening derived from 497 male elite athletes

Adaptive versus maladaptive right ventricular remodelling

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