Objective Measures of Right Ventricular Function During Exercise: Results of a Pilot Study

Background: A growing body of evidence seems to suggest that reduction in right ventricular (RV) systolic function is not only associated with both development of symptoms associated with pulmonary arterial hypertension (PAH) but also increased morbidity and adverse clinical outcomes. Recent data suggest that supine bicycle stress echocardiography (sBEE) is feasible and provides realistic resistance and compliance estimations.

Methods: The study design was a retrospective analysis of sBEE obtained for clinical indications of dyspnea on exertion or unexplained exercise intolerance. A total of 30 sBEE studies were included. The first 10 sBEE studies served as a calibration cohort not only to establish objective measures of RV performance but also to determine feasibility and reproducibility. The following 20 sBEE served as a validation cohort.

Results: Our results demonstrate that tricuspid annular plane systolic excursion and tricuspid annular systolic velocity, even when measured by an untrained reader, are reliable and accurate measures of the RV response to exercise during a sBEE protocol. Furthermore, measurements of RV myocardial performance (Tei index) or peak RV strain during exercise not only are time consuming but also simply unreliable and should not be utilized to evaluate RV function during sBEE.

Conclusion: The results of our pilot study suggest that sBEE might be promising for detecting RV abnormalities during exercise. A larger prospective study is now needed to determine if TAPSE and tricuspid annular systolic velocity recorded during sBEE might be useful in assessing patients presenting with dyspnea during exercise or suspected of having PAH.