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 ,

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.