Exercise Hemodynamics and Sex-Specific Data in Asymptomatic Adults: An Exploratory Pilot Study

Background: Understanding normal exercise hemodynamics is essential for assessing individuals with exertional dyspnea. This study utilized exercise echocardiography to gain insights into exercise hemodynamics in asymptomatic middle-aged to older adults without overt cardiovascular disease. Methods: We prospectively enrolled 30 individuals aged 45-75 years without dyspnea, excluding those with left ventricular ejection fraction (LVEF) < 50% or significant heart/lung diseases. All participants underwent symptom-limited bicycle exercise echocardiography. Results: Two individuals exhibited early-stage dyspnea, leading to the inclusion of 28 individuals (mean age 61 ± 8 years, 50% female) in the final analysis. Throughout the exercise, the average E/e' ratio increased from 8.3 ± 1.6 at rest to 9.7 ± 1.8 at 75 W (p = 0.001), while systolic pulmonary artery pressure (SPAP) rose from 23.0 ± 3.9 mmHg at rest to 41.2 ± 9.3 mmHg at 75 W (p < 0.001). Sex-specific analysis revealed a more pronounced elevation in SPAP during exercise among females (SPAP at 75 W, 45.5 ± 8.3 in females; 36.8 ± 8.3 mmHg in males, p = 0.011; p < 0.001 for interaction between sexes). Conclusions: In asymptomatic middle-aged to older adults, while there was a slight increase in left ventricular filling pressure and SPAP during exercise, the mean average E/e' and SPAP at peak exercise were below 10 and 50 mmHg, respectively. Our findings also demonstrate sex-specific differences, with females exhibiting a more pronounced elevation in SPAP during exercise.