Changes in Right Ventricular Function with Exercise in Healthy Subjects: Optimal Parameters and Effects of Gender and...

Right ventricular (RV) function augments with exercise, and loss of this adaptive ability often determines symptoms. Reports on exercise-related changes in RV function in healthy subjects are sparse. In this study, healthy volunteers were prospectively recruited, and changes in RV function with exercise were examined, optimal parameters determined, and the effects of gender and age examined.

Treadmill exercise stress echocardiography with concurrent expired gas analysis was performed in 121 healthy volunteers. Parameters of RV systolic function (RV fractional area change, Doppler tissue s' velocity, and systolic strain and strain rate) and diastolic function (peak E and A velocity, Doppler tissue e', a' and early and late diastolic strain rate) were evaluated at baseline and after exercise, with the difference (Δ) being systolic and diastolic reserve. Changes in pulmonary arterial pressure (PAP) was measured when accurate estimation was possible.

Most systolic functional parameters were augmented with exercise. However, systolic augmentation decreased with age (Δs': r = -0.31, P < .01; Δ strain: r = -0.28, P = .008; Δ systolic strain rate: r = -0.31, P < .01). Similar changes were observed with diastolic function (Δe': r = -0.33, P < .01; Δ early diastolic strain rate r = -0.20, P = .04). In the subgroup with PAP measurements, ΔPAP (r = 0.32, P < .01) increased with age. Men had greater augmentation of systolic reserve, but differences were negated when corrected for workload. S' velocity was the most robust measure of RV systolic function.

There is a modest yet significant reduction in RV systolic and diastolic reserve with age, with an increase in PAP. S' velocity is a robust and feasible measure that should be considered given the increasing use of stress testing to evaluate RV function.