title: Echocardiographic assessment of right ventricular contractile reserve in healthy subjects.
abstract: BACKGROUND
  Exercise-induced increase in pulmonary artery systolic pressure (PASP) as a possible measure of right ventricular (RV) contractile reserve has been shown to predict survival in severe pulmonary hypertension. However, RV contractile reserve can also be measured by changes in stroke volume (SV), tricuspid annular plane systolic excursion (TAPSE), or tricuspid annular systolic velocity (S'). The limits of normal values and the functional significance of these changes in healthy subjects are not well known.
  
  
  METHODS
  In this prospective study, 90 healthy subjects (45 male, mean age 39 ± 13 years) underwent exercise stress echocardiography with measurement of TAPSE, S', TAPSE/PASP, SV, and PASP at rest and peak exercise. Maximum and minimum normal values were reported for all indices.
  
  
  RESULTS
  Normal values of exercise-induced changes (Δ) were 4 to 10 mm for TAPSE, 6 to 14 cm/s for S', 12 to 57 mm Hg for PASP, 0 to 96 mL for SV, and -1.2 to 0 mm/mm Hg for TAPSE/PASP. At peak exercise, women showed lower ΔTAPSE/PASP, ΔPASP, ΔS', and ΔSV, but higher TAPSE/PASP than men. Aging was associated with decreased ΔTAPSE/PASP, ΔTAPSE, ΔS', ΔPASP, and ΔSV. In addition, ΔS', ΔTAPSE/PASP, ΔPASP, and ΔSV, but not ΔTAPSE, were directly correlated with maximum workload.
  
  
  CONCLUSIONS
  Our results provide age- and sex-related limits of normal for RV contractile reserve as assessed by exercise stress echocardiography and demonstrate that RV systolic function indices (PASP, TAPSE, S', and TAPSE/PASP) correlate with maximum exercise capacity.
authors.affiliation: Department of Cardiology, Second University of Naples-Monaldi Hospital, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: D'Alto
authors.affiliation: Department of Cardiology, Molière Longchamp Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Adriana
authors.initials: A
authors.lastname: Pavelescu
authors.affiliation: Department of Cardiology, Second University of Naples-Monaldi Hospital, Naples, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Argiento
authors.affiliation: Department of Cardiology, Second University of Naples-Monaldi Hospital, Naples, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Romeo
authors.affiliation: Department of Cardiology, Second University of Naples-Monaldi Hospital, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Correra
authors.affiliation: Department of Cardiology, Second University of Naples-Monaldi Hospital, Naples, Italy.
authors.forename: Giovanni Maria
authors.initials: GM
authors.lastname: Di Marco
authors.affiliation: Department of Cardiology, Second University of Naples-Monaldi Hospital, Naples, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.affiliation: Department of Cardiology, Second University of Naples-Monaldi Hospital, Naples, Italy.
authors.forename: Berardo
authors.initials: B
authors.lastname: Sarubbi
authors.affiliation: Department of Cardiology, Second University of Naples-Monaldi Hospital, Naples, Italy.
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.affiliation: Department of Pathophysiology, Erasme University Hospital, Brussels, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Naeije
mesh_terms: D000328:Adult; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D064368:Healthy Volunteers; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole; D016278:Ventricular Function, Right / Q000502:physiology*; D055815:Young Adult
keywords: echocardiography; right ventricular function