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Related Concept Videos

Regulation of Stroke Volume01:27

Regulation of Stroke Volume

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The regulation of stroke volume, which is the amount of blood the heart pumps out during each heartbeat, is critical for maintaining a healthy circulatory system. Stroke volume is influenced by three main factors: preload, contractility, and afterload.
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
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Updated: Nov 11, 2025

Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
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Exercise right ventricular ejection fraction predicts right ventricular contractile reserve.

Catherine G Ireland1, Rachel L Damico2, Todd M Kolb2

  • 1Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|March 23, 2021
PubMed
Summary

Exercise right ventricular ejection fraction effectively identifies hidden heart dysfunction in pulmonary hypertension, outperforming resting measures and predicting clinical outcomes.

Keywords:
exerciseheart ventriclespulmonary hypertension

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Area of Science:

  • Cardiology
  • Pulmonary Hypertension Research
  • Cardiac Physiology

Background:

  • Right ventricular (RV) contractile reserve is a potential marker for detecting RV dysfunction in pulmonary vascular disease.
  • Identifying reliable measures of RV contractile reserve is crucial for early diagnosis and management.

Purpose of the Study:

  • To determine which measure of RV contractile reserve during exercise best predicts occult RV dysfunction.
  • To assess the predictive value of RV contractile reserve for clinical outcomes in patients with pulmonary hypertension.

Main Methods:

  • Prospective study of 35 subjects with suspected or known pulmonary hypertension undergoing right heart catheterization.
  • Utilized cardiac MRI, echocardiography, and invasive cardiopulmonary exercise testing with RV pressure-volume catheterization.
  • Monitored event-free survival for 4 years post-procedure.

Main Results:

  • Lack of RV contractile reserve correlated with acute RV dilation during exertion (R²=0.76, p<0.001).
  • Exercise RV end-systolic elastance (Ees) and dilation changes predicted resting RV-pulmonary artery dysfunction.
  • Reduced exercise RV ejection fraction was the strongest predictor of occult RV dysfunction and clinical worsening.

Conclusions:

  • Exercise RV ejection fraction serves as a robust index of RV contractile reserve.
  • This measure excels at identifying occult RV dysfunction, surpassing resting RV function assessments.
  • Exercise RV ejection fraction may also predict clinical outcomes in pulmonary vascular disease.