Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni Di Dio E Ruggi D'Aragona", Salerno, Italy.
Institute of Clinical Physiology - C.N.R, Pisa, Italy.
Int J Cardiovasc Imaging. 2021 Jul;37(7):2151-2167. doi: 10.1007/s10554-021-02243-x. Epub 2021 Apr 18.
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 velocity (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.
运动多普勒超声心动图（EDE）是一种在缺血性和瓣膜性心脏病中得到充分验证的工具。然而，它在评估右心和肺循环单位（RH-PCU）中的应用是有限的。本研究的目的是评估半卧位自行车 EDE 在评估大的多中心人群中的 RH-PCU 的可行性，这些人群包括健康个体、精英运动员以及有或有发展为肺动脉高压（PH）风险的患者。从 2019 年 1 月至 2019 年 7 月，954 例受试者（平均年龄 54.2±16.4 岁，范围 16-96 岁，430 例女性）在 7 个参与 RIGHT Heart International NETwork（RIGHT-NET）的中心接受了标准化的半卧位自行车 EDE 检查，每 2 分钟增加 25 瓦的负荷。EDE 右心结构、功能和压力参数根据当前建议获得。通过三尖瓣环平面收缩期位移（TAPSE），940 例中的 903 例（96%），通过组织多普勒衍生的三尖瓣侧瓣环收缩速度（S'），751 例中的 667 例（89%），通过右心室分数面积变化（RVFAC），在运动高峰时获得了右心室功能。在 954 例患者中，894 例（93.7%）在休息时和 816 例（85.5%）在运动高峰时获得了 RV-RA 梯度[RV-RA 梯度=4×三尖瓣反流速度（TRV）]。如果同时考虑 TRV 和/或右心室流出道加速时间（RVOT AcT），估计肺动脉压力的可行性率提高到 95%以上。在高专业超声心动图实验室，半卧位自行车 EDE 是评估 RH-PCU 压力和功能的一种可行工具。
