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Updated: Aug 7, 2026
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Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Normal limits for the right ventricle-pulmonary circulation exercise echocardiography: a meta-analysis
Francesco Ferrara1,2, Valentina Capone3,2, Monica Franzese4
1Department of Advanced Medical Sciences, "Federico II" University of Naples, Naples, Italy.
Summary
This meta-analysis establishes normal limits for exercise Doppler echocardiography (ex-TTE) measurements of the right ventricle, pulmonary artery, and left atrial (RV-PA-LA) unit in healthy adults. These findings provide a crucial reference for interpreting ex-TTE results.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Physiology
Background:
- Normal reference ranges for exercise Doppler echocardiography (ex-TTE) of the right ventricle, pulmonary artery, and left atrial (RV-PA-LA) unit are not well-defined.
- Accurate interpretation of ex-TTE requires established normal limits for key hemodynamic and functional parameters.
Purpose of the Study:
- To establish normal reference limits for exercise Doppler echocardiography (ex-TTE) measurements of the RV-PA-LA unit in healthy individuals.
- To provide a robust framework for the clinical interpretation of ex-TTE data.
Main Methods:
- A comprehensive meta-analysis was conducted using data from Medline, Web of Science, and Scopus databases.
- Included studies involved healthy subjects undergoing supine/semi-recumbent cycle ergometer ex-TTE, reporting parameters like TRV, sPAP, mPAP, mPAP/CO slope, E/e', TAPSE, and TAPSE/sPAP.
- Pooled mean estimates and 5th/95th percentiles (LLN/ULN) were calculated using a random-effects model.
Main Results:
- Data from 19 studies including 1122 healthy subjects were analyzed.
- Pooled estimates and upper/lower limits of normal (ULN/LLN) were determined for TRV (2.5 m/s, ULN 3.4), sPAP (38.5 mmHg, ULN 57.8), mPAP (29.8 mmHg, ULN 43.0), mPAP/CO slope (1.4 mmHg·min·L⁻¹, ULN 3.0), E/e' (7.1, ULN 11.5), TAPSE (31.8 mm, LLN 24.6), and TAPSE/sPAP (0.8 mm·mmHg⁻¹, LLN 0.4).
- Significant heterogeneity was observed for several measurements, but a robust framework was established.
Conclusions:
- This meta-analysis provides essential normal reference limits for exercise Doppler echocardiography measurements of the RV-PA-LA unit.
- These established limits will aid clinicians in accurately interpreting ex-TTE findings in healthy individuals and potentially in patient populations.
- Further research may explore the impact of different exercise protocols and populations on these reference values.
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