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Original Research: Pulmonary Vascular Disease |

Echocardiography of the Pulmonary Circulation and Right Ventricular FunctionEchocardiography and Pulmonary Circulation: Exploring the Physiologic Spectrum in 1,480 Normal Subjects

Antonello D’Andrea, MD; Robert Naeije, MD; Ekkehard Grünig, MD; Pio Caso, MD; Michele D’Alto, MD; Enza Di Palma, MD; Luigi Nunziata, MD; Lucia Riegler, MD; Raffaella Scarafile, MD; Rosangela Cocchia, MD; Olga Vriz, MD; Rodolfo Citro, MD; Raffaele Calabrò, MD; Maria Giovanna Russo, MD; Eduardo Bossone, MD, PhD, FCCP
Author and Funding Information

From the Department of Cardiology (Drs D’Andrea, Caso, D’Alto, Di Palma, Nunziata, Riegler, Scarafile, and Cocchia and Profs Calabrò and Russo), Monaldi Hospital, Second University of Naples, Naples, Italy; the Cardiology Clinic (Dr Naeije), Erasme Academic Hospital, Free University of Brussels, Brussels, Belgium; the Centre of Pulmonary Hypertension (Dr Grünig), Thoraxclinic, University Hospital Heidelberg, Heidelberg, Germany; the Department of Cardiology (Dr Vriz), S. Antonio Hospital, San Daniele del Friuli, Udine, Italy; the Department of Cardiology (Dr Citro), University Hospital, San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy; and the Department of Cardiac Surgery (Prof Bossone), IRCCS Policlinico San Donato, Milan, Italy.

Correspondence to: Eduardo Bossone, MD, PhD, FCCP, Department of Cardiac Surgery, IRCCS Policlinico San Donato, Via Pr. Amedeo, 36-83023 Lauro (AV), Italy; e-mail: ebossone@hotmail.com


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(5):1071-1078. doi:10.1378/chest.12-3079
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Background:  Although transthoracic echocardiography (TTE) is an excellent noninvasive screening test for pulmonary hypertension, the physiologic range of Doppler echocardiography-derived pulmonary pressures remains not completely investigated. The aim of the present study was, therefore, to explore the full spectrum of pulmonary pressures and right ventricular (RV) functional indexes by TTE in healthy subjects and to investigate clinical and echocardiographic correlates.

Methods:  A random sample of 1,480 healthy individuals (mean age, 36.1 ± 15.5 years; range, 20-80 years; 905 men) underwent a comprehensive TTE. Pulmonary artery systolic pressure (PASP), mean pressure, and pulmonary vascular resistance were estimated by standard Doppler echocardiography formulas. In addition, RV diastolic (Doppler transtricuspid inflow measurements) and systolic indexes (RV fractional area change, RV tissue Doppler peak systolic velocity, tricuspid annular plane systolic excursion) were calculated.

Results:  PASP and mean pulmonary artery pressure values were significantly higher in subjects aged > 50 years and in those with a BMI > 30 kg/m2. In particular, a PASP > 40 mm Hg was found in 118 subjects (8%) of those aged > 50 years and in 103 (7%) of those with a BMI > 30 kg/m2. No differences by age were registered in RV systolic indexes and in pulmonary vascular resistances. On multivariate analysis, in the overall study population, age, BMI, mitral E/e′ ratio, and left ventricular stroke volume were the only independent predictors of PASP.

Conclusions:  This study delineates an estimate of pulmonary hemodynamics in a wide age range cohort of healthy subjects. Pulmonary pressures increased with age and BMI, as expected.

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