title: Echocardiography of the pulmonary circulation and right ventricular function: exploring the physiologic spectrum in 1,480 normal subjects.
abstract: BACKGROUND
  Although transthoracic echocardiography (TTE) is an excellent noninvasive screening test for pulmonary hypertension, the physiologic range of Doppler echocardiography-derived pulmonary pressures remains not completely investigated. The aim of the present study was, therefore, to explore the full spectrum of pulmonary pressures and right ventricular (RV) functional indexes by TTE in healthy subjects and to investigate clinical and echocardiographic correlates.
  
  
  METHODS
  A random sample of 1,480 healthy individuals (mean age, 36.1 ± 15.5 years; range, 20-80 years; 905 men) underwent a comprehensive TTE. Pulmonary artery systolic pressure (PASP), mean pressure, and pulmonary vascular resistance were estimated by standard Doppler echocardiography formulas. In addition, RV diastolic (Doppler transtricuspid inflow measurements) and systolic indexes (RV fractional area change, RV tissue Doppler peak systolic velocity, tricuspid annular plane systolic excursion) were calculated.
  
  
  RESULTS
  PASP and mean pulmonary artery pressure values were significantly higher in subjects aged &gt; 50 years and in those with a BMI &gt; 30 kg/m2. In particular, a PASP &gt; 40 mm Hg was found in 118 subjects (8%) of those aged &gt; 50 years and in 103 (7%) of those with a BMI &gt; 30 kg/m2. No differences by age were registered in RV systolic indexes and in pulmonary vascular resistances. On multivariate analysis, in the overall study population, age, BMI, mitral E/e' ratio, and left ventricular stroke volume were the only independent predictors of PASP.
  
  
  CONCLUSIONS
  This study delineates an estimate of pulmonary hemodynamics in a wide age range cohort of healthy subjects. Pulmonary pressures increased with age and BMI, as expected.
authors.affiliation: Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.affiliation: Cardiology Clinic, Erasme Academic Hospital, Free University of Brussels, Brussels, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Naeije
authors.affiliation: Centre of Pulmonary Hypertension, Thoraxclinic, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Grünig
authors.affiliation: Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Pio
authors.initials: P
authors.lastname: Caso
authors.affiliation: Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: D'Alto
authors.affiliation: Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Enza
authors.initials: E
authors.lastname: Di Palma
authors.affiliation: Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Nunziata
authors.affiliation: Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Riegler
authors.affiliation: Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Scarafile
authors.affiliation: Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Rosangela
authors.initials: R
authors.lastname: Cocchia
authors.affiliation: Department of Cardiology, S. Antonio Hospital, San Daniele del Friuli, Udine, Italy.
authors.forename: Olga
authors.initials: O
authors.lastname: Vriz
authors.affiliation: Department of Cardiology, University Hospital, San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.affiliation: Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
authors.affiliation: Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.affiliation: Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy. Electronic address: ebossone@hotmail.com.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011652:Pulmonary Circulation / Q000502:physiology*; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012016:Reference Values; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016278:Ventricular Function, Right / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*; D055815:Young Adult