Skip to main content
SpringerLink
Log in

Measurement of pulmonary transit time and estimation of pulmonary blood volume after exercise using contrast echocardiography

  • Original Investigation
  • Published:
Journal of Echocardiography Aims and scope Submit manuscript

Abstract

Background

Pulmonary transit time (PTT) and pulmonary blood volume (PBV) derived from non-invasive imaging correlate with pulmonary artery wedge pressure. The response of PBV to exercise may be useful in the evaluation of cardiopulmonary disease but whether PBV can be obtained reliably following exercise is unknown. We therefore aimed to assess the technical feasibility of measuring PTT and PBV after exercise using contrast echocardiography.

Methods

In healthy volunteers, PTT was calculated from time-intensity curves generated as contrast traversed the cardiac chambers before and immediately after participants performed sub-maximal exercise on the Standard Bruce Protocol. From the product of PTT and heart rate (HR) during contrast passage through the pulmonary circulation, PBV relative to systemic stroke volume (rPBV) was calculated.

Results

The cohort consisted of 14 individuals (age: 46 ± 8 years; 2 female) without cardiopulmonary disease. Exercise time was 8 ¾ ± 1 ¾ minutes and participants reached 85 ± 9% of age-predicted maximal HR, which corresponded to a near-doubling of resting HR at the time of post-exercise contrast injection. Data sufficient to derive PTT and rPBV were obtained for all participants. With exercise, the change in PBV from baseline ranged from 56 to 138% of systemic stroke volume, consistent with rPBV and absolute PBV values obtained in prior studies.

Conclusions

Acquisition of PTT and rPBV using contrast echocardiography after exercise is achievable and the results are physiologically plausible. As the next step towards clinical implementation, validation of this technique against hemodynamic exercise studies appears reasonable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Monahan K, Lenihan D, Brittain EL, et al. The relationship between pulmonary artery wedge pressure and pulmonary blood volume derived from contrast echocardiography: a proof of concept study. Echocardiography. 2018;35:1266–70.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Seraphim A, Knott KD, Menacho K, et al. Prognostic value of pulmonary transit time and pulmonary blood volume estimation using myocardial perfusion CMR. J Am Coll Cardiol Img. 2021;14:2107–19.

    Article  Google Scholar 

  3. Borlaug BA. Evaluation and management of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2020;17:559–73.

    Article  CAS  PubMed  Google Scholar 

  4. Pandey A, Khera R, Park B, et al. Relative impairments in hemodynamic exercise reserve parameters in heart failure with preserved ejection fraction: a study-level pooled analysis. J Am Coll Cardiol Heart Fail. 2018;6:117–26.

    Google Scholar 

  5. Ha JW, Oh JK, Pellikka PA, et al. Diastolic stress echocardiography: a novel noninvasive diagnostic test for diastolic dysfunction using supine bicycle exercise Doppler echocardiography. J Am Soc Echocardiogr. 2005;18:63–8.

    Article  PubMed  Google Scholar 

  6. Prasad SB, Holland DJ, Atherton JJ. Diastolic stress echocardiography: from basic principles to clinical applications. Heart. 2018;104:1739–48.

    Article  CAS  PubMed  Google Scholar 

  7. Ho JE, Redfield MM, Lewis GD, et al. Deliberating the diagnostic dilemma of heart failure with preserved ejection fraction. Circulation. 2020;142:1770–80.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Brittain EL, Doss LN, Saliba L, et al. Feasibility and diagnostic potential of pulmonary transit time measurement by contrast echocardiography: a pilot study. Echocardiography. 2015;32:1564–71.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bruce RA, Blackmon JR, Jones JW, et al. Exercise testing in adult normal subjects and cardiac patients. Pediatrics. 1963;32:742–56.

    Article  Google Scholar 

  10. Monahan K, Coffin S, Lawson M, et al. Pulmonary transit time from contrast echocardiography and cardiac magnetic resonance imaging: comparison between modalities and the impact of region of interest characteristics. Echocardiography. 2019;36:119–24.

    Article  PubMed  Google Scholar 

  11. Boronyak SM, Monahan K, Brittain EL, et al. An inflection point method for the determination of pulmonary transit time from contrast echocardiography. IEEE Trans Biomed Eng. 2015;62:1853–61.

    Article  PubMed  Google Scholar 

  12. Lewis JF, Kuo LC, Nelson JG, et al. Pulsed Doppler echocardiographic determination of stroke volume and cardiac output: clinical validation of two new methods using the apical window. Circulation. 1984;3:425–31.

    Article  Google Scholar 

  13. Schreiner BF Jr, Murphy GW, Glick G, et al. Effect of exercise on the pulmonary blood volume in patients with acquired heart disease. Circulation. 1963;27:559–64.

    Article  Google Scholar 

  14. Hopkins SR, Belzberg AS, Wiggs BR, et al. Pulmonary transit time and diffusion limitation during heavy exercise in athletes. Respir Physiol. 1996;103:67–73.

    Article  CAS  PubMed  Google Scholar 

  15. Naeije R, Chesler N. Pulmonary circulation at exercise. Compr Physiol. 2012;2:711–41.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Coffman KE, Carlson AR, Miller AD, et al. The effect of aging and cardiorespiratory fitness on the lung diffusing capacity response to exercise in humans. J Appl Physiol. 2017;122:1425–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Eldridge MW, Dempsey JA, Haverkamp HC, et al. Exercise-induced intrapulmonary arteriovenous shunting in healthy humans. J Appl Physiol. 2004;97:797–805.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank JoAnn Gottlieb RDCS for her sonographic excellence; Lana Howard RN, Lamar Bowman RN, and all the Clinical Research Center nurses and staff for their patience and assistance with study coordination and execution; Tim Olszewski MS and Heidi Silver PhD of the Vanderbilt Diet, Body Composition, and Human Metabolism Core for their expertise in operating the exercise equipment and software; and the study participants for generously volunteering their time. This work was supported by CTSA award No. UL1 TR002243 from the National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

Funding

National Center for Advancing Translational Sciences, UL1 TR002243.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Ken Monahan & Evan Brittain

  2. Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    James J. Tolle

Authors
  1. Ken Monahan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Evan Brittain
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James J. Tolle
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KM: concept/design, data acquisition/analysis/interpretation, drafting the manuscript, critical revision of the manuscript, approval of article, secured funding, data collection. EB: interpretation of data, critical revision of the article, approval of the article. JJT: interpretation of data, critical revision of the article, approval of the article.

Corresponding author

Correspondence to Ken Monahan.

Ethics declarations

Conflict of interest

Ken Monahan declares that he has no conflict of interest relevant to this research. Evan Brittain declares that he has no conflict of interest relevant to this research. James Tolle declares he has no conflict of interest relevant to this research.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent was obtained from all patients being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Monahan, K., Brittain, E. & Tolle, J.J. Measurement of pulmonary transit time and estimation of pulmonary blood volume after exercise using contrast echocardiography. J Echocardiogr 21, 16–22 (2023). https://doi.org/10.1007/s12574-022-00582-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12574-022-00582-9

Keywords

Search

Navigation