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Feasibility of the exercise stress echocardiography for the evaluation of the right heart and pulmonary circulation unit in different clinical conditions: the right heart international network

Session Stress echocardiography in 2020

Speaker Francesco Ferrara

Event : EuroEcho 2019

  • Topic : imaging
  • Sub-topic : Stress Echocardiography
  • Session type : Rapid Fire Abstracts

Authors : F Ferrara (Salerno,IT), L Gargani (Pisa,IT), M Guazzi (San Donato Milanese,IT), M D'alto (Napoli,IT), K Wierzbowska Drabik (Lodz,PL), P Argiento (Napoli,IT), R Cocchia (Naples,IT), F Bandera (San Donato Milanese,IT), C Contaldi (Salerno,IT), S Lanero (Naples,IT), V Russo (Naples,IT), O Vriz (Riyadh,SA), A D'andrea (Nocera Inferiore,IT), JD Kasprzak (Lodz,PL), E Bossone (Naples,IT)

Authors:
F Ferrara1 , L Gargani2 , M Guazzi3 , M D'alto4 , K Wierzbowska Drabik5 , P Argiento4 , R Cocchia6 , F Bandera3 , C Contaldi1 , S Lanero7 , V Russo8 , O Vriz9 , A D'andrea10 , JD Kasprzak5 , E Bossone6 , 1Cardiology Division Cava deTirreni-Amalfi Coast, University Hospital of Salerno - Salerno - Italy , 2Institute of Clinical Physiology (IFC) - Pisa - Italy , 3IRCCS Policlinico San Donato - San Donato Milanese - Italy , 4Second University of Naples, Department of Cardiology - Napoli - Italy , 5Medical University of Lodz - Lodz - Poland , 6Cardarelli Hospital - Naples - Italy , 7SDN Foundation IRCCS - Naples - Italy , 8Federico II University of Naples - Naples - Italy , 9King Faisal Specialist Hospital & Research Centre - Riyadh - Saudi Arabia , 10Hospital Umberto I - Nocera Inferiore - Italy ,

On behalf: RIGHT Heart International NETwork (RIGHT-NET)

Topic(s):
Stress Echocardiography

Purpose: Exercise stress echocardiography (ESE) is a well-validated tool in ischemic and valvular heart diseases. The aim of this study is to assess the ESE feasibility for the evaluation of the right heart pulmonary circulation unit (RH-PCU) in a large cohort of subjects, from healthy individuals and elite athletes to patients with overt or at risk of developing pulmonary hypertension. Methods: 954 subjects [mean age 54.2±16.4 years, 430 women]  [254 healthy volunteers, 40 elite athletes, 363 patients with cardiovascular risk factors, 25 with pulmonary arterial hypertension, 149  with connective tissue diseases, 81  with left heart and valvular diseases, 42 with lung diseases], underwent standardized semi-recumbent cycle ergometer ESE with an incremental workload of 25 watts every 2 minutes up to  symptom-limited maximal tolerated workload. ESE parameters of right heart structure, function and pressures were obtained according current recommendations. Results: The success rate for the evaluation of the RV function at peak exercise was 903/940 (96%) for tricuspid annular plane systolic excursion (TAPSE), 667/751 (89%) for tissue Doppler–derived tricuspid lateral annular systolic velocity (S’) and 425/772 (63%) for right ventricular fractional area change (RVFAC). Right ventricular–right atrial pressure gradient [RV-RA gradient = 4 x tricuspid regurgitation velocity2] was obtained in 894/954 patients (93.7 %) at rest and in 816/954 (85.5%) at peak exercise. At peak exercise, pulmonary acceleration time (AcT) was feasible among 435/545 (82.5%) patients (Table 1). Conclusions: In daily ESE monitoring of TAPSE and S’ resulted to be less challenging than of RV FAC. ESE was a feasible tool for the evaluation of RV-RA gradient and pulmonary AcT.

Parameters

Rest

mean±SD

Peak

mean±SD

P value

Assessed

n (%)

Feasibility at rest

n (%)

Feasibility at peak

n (%)

RVED area (cm2)

17.4±5.7

17.4±5.8

0.9

672

632 (94.0)

425 (63.2)

RVES area (cm2)

9.7±4.3

9.6±4.9

0.7

672

632 (94.0)

425 (63.2)

TAPSE (mm)

22.9±3.9

27.4±5.5

<0.001

940

922 (98.1)

903 (96.0)

S’(cm/s)

13.1±2.9

18.5±5.0

<0.001

751

746 (99.4)

667 (88.8)

RVFAC (%)

45.7±10

46.7±11

0.121

672

632 (94.0)

425 (63.2)

RV-RA gradient (mmHg)

24.3±15

42.5±20

<0.001

954

894 (93.7)

816 (85.5)

Pulmonary AcT (m/s)

129±31

116±35

<0.001

545

527( 96.7)

435 (82.5)

RVED, right ventricle end diastolic area; RVES, right ventricle end systolic area; p values indicate differences at rest and peak exercise. The term “assessed” indicates that an attempt was done in order to measure the parameter. The term “feasibility” indicates that it was possible to measure the parameter that was assessed.

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