Exercise echocardiography revealed that a resting TAPSE/sPAP ratio <0.7 mm/mm Hg and a mean pulmonary artery pressure-cardiac output >5 mm Hg.min/L predicted increased all-cause mortality.
Cohort (n=2,228)
Yes
Does exercise echocardiography of the right ventricle and pulmonary circulation differentiate physiological from pathologic responses and predict all-cause mortality across different clinical conditions?
Exercise echocardiography establishes normal versus pathologic limits for right ventricular and pulmonary circulation responses, demonstrating that resting TAPSE/sPAP <0.7 mm/mm Hg and mPAP-CO >5 mm Hg.min/L predict increased all-cause mortality.
BACKGROUND Exercise echocardiography is used for assessment of pulmonary circulation and right ventricular function, but limits of normal and disease-specific changes remain insufficiently established. OBJECTIVES The objective of this study was to explore the physiological vs pathologic response of the right ventricle and pulmonary circulation to exercise. METHODS A total of 2,228 subjects were enrolled: 375 healthy controls, 40 athletes, 516 patients with cardiovascular risk factors, 17 with pulmonary arterial hypertension, 872 with connective tissue diseases without overt pulmonary hypertension, 113 with left-sided heart disease, 30 with lung disease, and 265 with chronic exposure to high altitude. All subjects underwent resting and exercise echocardiography on a semirecumbent cycle ergometer. All-cause mortality was recorded at follow-up. RESULTS The 5th and 95th percentile of the mean pulmonary artery pressure-cardiac output relationships were 0.2 to 3.5 mm Hg.min/L in healthy subjects without cardiovascular risk factors, and were increased in all patient categories and in high altitude residents. The 5th and 95th percentile of the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio at rest were 0.7 to 2.0 mm/mm Hg at rest and 0.5 to 1.5 mm/mm Hg at peak exercise, and were decreased at rest and exercise in all disease categories and in high-altitude residents. An increased all-cause mortality was predicted by a resting tricuspid annular plane systolic excursion to systolic pulmonary artery pressure 5 mm Hg.min/L. CONCLUSIONS 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. (Right Heart International NETwork During Exercise in Different Clinical Conditions; NCT03041337).
Gargani et al. (2023) conducted a cohort in Various cardio-respiratory conditions and healthy subjects (n=2,228). Exercise echocardiography vs. Healthy controls was evaluated on All-cause mortality. Exercise echocardiography revealed that a resting TAPSE/sPAP ratio <0.7 mm/mm Hg and a mean pulmonary artery pressure-cardiac output >5 mm Hg.min/L predicted increased all-cause mortality.