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Age-changes in right ventricular function–pulmonary circulation coupling: from pediatric to adult stage in 1899 healthy subjects. The RIGHT Heart International NETwork (RIGHT-NET)

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Abstract

The present study analyzes age-specific changes in RV function and RV–PA coupling in a large cohort of apparently healthy subjects with a wide age-range, to identify reference values and to study the influence of clinical and echocardiographic cofactors. 1899 Consecutive healthy subjects underwent a standardized transthoracic echocardiographic examination. Tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) were measured. Ventriculo-arterial coupling was then inferred from the TAPSE/SPAP ratio. A quantile regression analysis was used to estimate quantiles 0.05, 0.10, 0.50 (median), 0.90, and 0.95 of TAPSE, SPAP and TAPSE/SPAP. The association between age and each of these values was determined. The mean age of the group was 45.2 ± 18.5 years (range 1 to 102 years), 971 were males. SPAP increased with age, whereas TAPSE and TAPSE/SPAP ratio decreased. Upon multivariate modeling, the most significant positive associations for TAPSE were body surface area (BSA) driven by the pediatric group, stroke volume (SV), E/A and negatively heart rate and E/e′ ratio. SPAP was positively associated with increasing age, SV, E/A, E/e′ and negatively with BSA. TAPSE/SPAP ratio was negatively associated with age, female sex, and E/e′ and positively with BSA. A preserved relationship between TAPSE and SPAP was found across the different age groups. TAPSE, SPAP and TAPSE/SPAP demonstrate important trends and associations with advancing age, impaired diastolic function, affected by female sex and BSA However the relationship between TAPSE and SPAP is relatively well preserved across the age spectrum.

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Abbreviations

BMI:

Body mass index

BSA:

Body surface area

HR:

Heart rate

LV:

Left ventricle

MAP:

Mean arterial pressure

PA:

Pulmonary artery

RAP:

Right atrial pressure

RV:

Right ventricular

SPAP:

Systolic pulmonary artery pressure

SV:

Stroke volume

TTE:

Transthoracic echocardiographic

TAPSE:

Tricuspid annular plane systolic excursion

TRV:

Tricuspid regurgitation velocity

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Author information

Authors and Affiliations

  1. Cardiac Centre, King Faisal Specialist Hospital and Research Center, Zahrawi St, Al Maather, Al Maazer, Riyadh, 12713, Saudi Arabia

    Olga Vriz, Gruschen Veldman & Sarah Aldosari Radaan

  2. School of Medicine, Alfaisal University, Riyadh, Saudi Arabia

    Olga Vriz

  3. Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Luna Gargani

  4. Heart Department, University Hospital of Salerno, Salerno, Italy

    Francesco Ferrara

  5. Department of Political Sciences, University of Pisa, Pisa, Italy

    Paolo Frumento

  6. Department of Cardiology, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Michele D’Alto

  7. Division of Cardiology, Umberto I° Hospital Nocera Inferiore, Salerno, Italy

    Antonello D’Andrea

  8. Division of Cardiac Rehabilitation-Echo Lab, A Cardarelli Hospital, Naples, Italy

    Rosangela Cocchia & Eduardo Bossone

  9. Department of Translational Medical Sciences, Federico II University, Naples, Italy

    Alberto Maria Marra & Antonio Cittadini

  10. IRCCS SDN, Naples, Italy

    Brigida Ranieri, Andrea Salzano & Filippo Cademartiri

  11. Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy

    Anna Agnese Stanziola

  12. Centre for Rare Respiratory Diseases, A.O. dei Colli Monaldi Hospital, Naples, Italy

    Anna Agnese Stanziola

  13. Centre Hospitalier Lunéville, Service de Cardiologie, Lunéville, France

    Damien Voilliot

  14. Institute of Family Medicine, University of Szeged, Szeged, Hungary

    Gergely Agoston

  15. Bieganski Hospital, Medical University of Lodz, Lodz, Poland

    Jaroslaw D. Kasprzak

  16. Center of Pulmonary Hypertension, Thoraxklinik Heidelberg at Heidelberg University Hospital, Heidelberg, Germany

    Ekkehard Grünig

  17. Heart Failure Unit, Cardiopulmonary Laboratory, University Cardiology Department, IRCCS Policlinico San Donato University Hospital, Milan, Italy

    Francesco Bandera & Marco Guazzi

  18. Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, QC, Canada

    Lawrence Rudski

Authors
  1. Olga Vriz
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  2. Gruschen Veldman
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  3. Luna Gargani
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  20. Francesco Bandera
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  22. Lawrence Rudski
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  23. Eduardo Bossone
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by OV, LG, PF, GV, EB and by all co-authors. The first draft of the manuscript was written by OV and LR and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Olga Vriz.

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Clinicaltrials Gov Identifier: NCT03041337.

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Fig. 1S

Scatterplot of age vs SPAP at the top and TAPSE/SPAP at the bottom with quantile regression lines (modeled through natural cubic splines) of order 0.05, 0.10, 0.5, 0.90, 0.95, in males and females separately. Supplementary file1 (TIFF 186 kb)

Fig. 2S

Scatterplot of age vs TAPSE at the top and TAPSE/BSA at the bottom with quantile regression lines (modeled through natural cubic splines) of order 0.05, 0.10, 0.5, 0.90, 0.95, in males and females separately. Supplementary file2 (TIFF 83 kb)

Supplementary file3 (DOCX 82 kb)

Appendices

Appendix

The Right Heart International Network (RIGHT-NET) Investigators

Co-Principal Investigators Eduardo Bossone (A Cardarelli Hospital, Naples, Italy), Luna Gargani (Institute of Clinical Physiology, CNR, Pisa, Italy), Robert Naeije (Free University of Brussels, Brussels, Belgium).

Study Coordinator Francesco Ferrara (Cava de’ Tirreni and Amalfi Coast Division of Cardiology, University Hospital, Salerno, Italy).

Co-investigators William F. Armstrong, Theodore John Kolias (University of Michigan, Ann Arbor, USA); Eduardo Bossone, Rosangela Cocchia, Ciro Mauro, Chiara Sepe (A Cardarelli Hospital, Naples, Italy); Filippo Cademartiri, Brigida Ranieri, Andrea Salzano (IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy); Francesco Capuano (Department of Industrial Engineering, Università di Napoli Federico II, Naples, Italy); Rodolfo Citro, Rossella Benvenga, Michele Bellino, Ilaria Radano (University Hospital of Salerno, Salerno, Italy); Antonio Cittadini, Alberto Marra, Roberta D’Assante, Salvatore Rega (Federico II University of Naples, Italy); Michele D’Alto, Paola Argiento (University of Campania “Luigi Vanvitelli”, Naples, Italy); Antonello D’Andrea (Umberto I° Hospital Nocera Inferiore, Italy); Francesco Ferrara, Carla Contaldi (Cava de’ Tirreni and Amalfi Coast Hospital, University Hospital of Salerno, Italy); Luna Gargani, Matteo Mazzola, Marco Raciti (Institute of Clinical Physiology, CNR, Pisa, Italy); Santo Dellegrottaglie (Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, Acerra – Naples, Italy); Nicola De Luca, Francesco Rozza, Valentina Russo (Hypertension Research Center, University Federico II of Naples, Italy); Giovanni Di Salvo (University of Padova, Italy; Imperial College, London, UK); Stefano Ghio, Stefania Guida (I.R.C.C.S. Policlinico San Matteo, Pavia, Italy); Ekkerard Grunig, Christina A. Eichstaedt (Heidelberg University Hospital, Germany); Marco Guazzi, Francesco Bandera, Valentina Labate (IRCCS Policlinico San Donato, University of Milan, Milan, Italy); André La Gerche (Baker Heart and Diabetes Institute, Melbourne, Australia); Giuseppe Limongelli, Giuseppe Pacileo, Marina Verrengia (University of Campania “Luigi Vanvitelli”, Naples, Italy); Jaroslaw D. Kasprzak, Karina Wierzbowska Drabik (Bieganski Hospital, Medical University of Lodz Poland); Gabor Kovacs, Philipp Douschan (Medical University of Graz, Graz, Austria); Antonella Moreo, Francesca Casadei, Benedetta De Chiara, (Niguarda Hospital, Milan, Italy); Robert Naeije (Free University of Brussels, Brussels, Belgium); Ellen Ostenfeld (Lund University, Skåne University Hospital, Sweden); Gianni Pedrizzetti (Department of Engineering and Architecture, University of Trieste); Francesco Pieri, Fabio Mori, Alberto Moggi-Pignone (Azienda Ospedaliero Universitaria Careggi, Florence, Italy); Lorenza Pratali (Institute of Clinical Physiology, CNR, Pisa, Italy); Nicola Pugliese (Department of Clinical and Experimental Medicine, University of Pisa, Italy); Rajan Saggar (UCLA Medical Center, Los Angeles, USA); Rajeev Saggar (Banner University Medical Center, Phoenix, Arizona, USA); Christine Selton-Suty, Olivier Huttin, Clément Venner (University Hospital of Nancy, France); Walter Serra, Francesco Tafuni (University Hospital of Parma, Italy); Anna Stanziola, Maria Martino, Giovanna Caccavo (Department of Respiratory Disease, Federico II University, Monaldi Hospital, Naples, Italy); István Szabó (University of Medicine and Pharmacy of Târgu Mureș, Târgu Mureș, Romania); Albert Varga, Gergely Agoston (University of Szeged, Szeged, Hungary); Darmien Voilliot (Centre Hospitalier Lunéville, France); Olga Vriz (Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia); Mani Vannan, Sara Mobasseri, Peter Flueckiger, Shizhen Liu (Piedmont Heart Institute, USA).

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Vriz, O., Veldman, G., Gargani, L. et al. Age-changes in right ventricular function–pulmonary circulation coupling: from pediatric to adult stage in 1899 healthy subjects. The RIGHT Heart International NETwork (RIGHT-NET). Int J Cardiovasc Imaging 37, 3399–3411 (2021). https://doi.org/10.1007/s10554-021-02330-z

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