Exercise Doppler echocardiography (EDE) is a well-validated tool in ischemic and valvular heart diseases. However, its use in the assessment of the right heart and pulmonary circulation unit (RH-PCU) is limited. The aim of this study is to assess the semi-recumbent bicycle EDE feasibility for the evaluation of RH-PCU in a large multi-center population, from healthy individuals and elite athletes to patients with overt or at risk of developing pulmonary hypertension (PH). From January 2019 to July 2019, 954 subjects [mean age 54.2 ± 16.4 years, range 16–96, 430 women] underwent standardized semi-recumbent bicycle EDE with an incremental workload of 25 watts every 2 min, were prospectively enrolled among 7 centers participating to the RIGHT Heart International NETwork (RIGHT-NET). EDE parameters of right heart structure, function and pressures were obtained according to current recommendations. Right ventricular (RV) function at peak exercise was feasible in 903/940 (96%) by tricuspid annular plane systolic excursion (TAPSE), 667/751 (89%) by tissue Doppler-derived tricuspid lateral annular systolic velocity (S′) and 445/672 (66.2%) by right ventricular fractional area change (RVFAC). RV—right atrial pressure gradient [RV–RA gradient = 4 × tricuspid regurgitation velocity2 (TRV)] was feasible in 894/954 patients (93.7%) at rest and in 816/954 (85.5%) at peak exercise. The feasibility rate in estimating pulmonary artery pressure improved to more than 95%, if both TRV and/or right ventricular outflow tract acceleration time (RVOT AcT) were considered. In high specialized echocardiography laboratories semi-recumbent bicycle EDE is a feasible tool for the assessment of the RH-PCU pressure and function.
Feasibility of semi-recumbent bicycle exercise Doppler echocardiography for the evaluation of the right heart and pulmonary circulation unit in different clinical conditions: the RIGHT heart international NETwork (RIGHT-NET) / Ferrara F.; Gargani L.; Naeije R.; Rudski L.; Armstrong W.F.; Wierzbowska-Drabik K.; Argiento P.; Bandera F.; Cademartiri F.; Citro R.; Cittadini A.; Cocchia R.; Contaldi C.; D'Alto M.; D'Andrea A.; Grunig E.; Guazzi M.; Kolias T.J.; Limongelli G.; Marra A.M.; Mauro C.; Moreo A.; Ranieri B.; Saggar R.; Salzano A.; Stanziola A.A.; Vriz O.; Vannan M.; Kasprzak J.D.; Bossone E.; Capuano F.; Benvenga R.; Bellino M.; Radano I.; Marra A.; D'Assante R.; Rega S.; Mazzola M.; Raciti M.; Dellegrottaglie S.; De Luca N.; Rozza F.; Russo V.; Di Salvo G.; Ghio S.; Guida S.; Grunig E.; Eichstaedt C.A.; Labate V.; La Gerche A.; Pacileo G.; Verrengia M.; Kovacs G.; Douschan P.; Casadei F.; De Chiara B.; Ostenfeld E.; Pedrizzetti G.; Pieri F.; Mori F.; Moggi-Pignone A.; Pratali L.; Pugliese N.; Saggar R.; Selton-Suty C.; Huttin O.; Venner C.; Serra W.; Tafuni F.; Stanziola A.; Martino M.; Caccavo G.; Szabo I.; Varga A.; Agoston G.; Voilliot D.; Mobasseri S.; Flueckiger P.; Liu S.. - In: THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING. - ISSN 1569-5794. - ELETTRONICO. - 37:(2021), pp. 2151-2167. [10.1007/s10554-021-02243-x]
Feasibility of semi-recumbent bicycle exercise Doppler echocardiography for the evaluation of the right heart and pulmonary circulation unit in different clinical conditions: the RIGHT heart international NETwork (RIGHT-NET)
Mori F.;Moggi-Pignone A.;
2021
Abstract
Exercise Doppler echocardiography (EDE) is a well-validated tool in ischemic and valvular heart diseases. However, its use in the assessment of the right heart and pulmonary circulation unit (RH-PCU) is limited. The aim of this study is to assess the semi-recumbent bicycle EDE feasibility for the evaluation of RH-PCU in a large multi-center population, from healthy individuals and elite athletes to patients with overt or at risk of developing pulmonary hypertension (PH). From January 2019 to July 2019, 954 subjects [mean age 54.2 ± 16.4 years, range 16–96, 430 women] underwent standardized semi-recumbent bicycle EDE with an incremental workload of 25 watts every 2 min, were prospectively enrolled among 7 centers participating to the RIGHT Heart International NETwork (RIGHT-NET). EDE parameters of right heart structure, function and pressures were obtained according to current recommendations. Right ventricular (RV) function at peak exercise was feasible in 903/940 (96%) by tricuspid annular plane systolic excursion (TAPSE), 667/751 (89%) by tissue Doppler-derived tricuspid lateral annular systolic velocity (S′) and 445/672 (66.2%) by right ventricular fractional area change (RVFAC). RV—right atrial pressure gradient [RV–RA gradient = 4 × tricuspid regurgitation velocity2 (TRV)] was feasible in 894/954 patients (93.7%) at rest and in 816/954 (85.5%) at peak exercise. The feasibility rate in estimating pulmonary artery pressure improved to more than 95%, if both TRV and/or right ventricular outflow tract acceleration time (RVOT AcT) were considered. In high specialized echocardiography laboratories semi-recumbent bicycle EDE is a feasible tool for the assessment of the RH-PCU pressure and function.
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