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Reference ranges and determinants of right ventricle outflow tract acceleration time in healthy adults by two-dimensional echocardiography

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Abstract

The right ventricular outflow tract acceleration time (RVOT-AT) has shown to progressively shorten with increasing degrees of pulmonary pressure. However, the physiologic ranges of RVOT AT are based on small sample sizes and have not been investigated regarding their determining factors. The aim of this study was to investigate reference values and determining factors of RVOT-AT in a large population of healthy subjects and by values described in the literature. In the first part of the study, 1029 healthy subjects (mean age 45.6 ± 16.0 years, 565 (54.7 %) females) were prospectively assessed by clinical examination including demography, vital signs and echocardiography. In the second part, we performed a pooled analysis of eight published studies describing RVOT-AT in healthy subjects (n = 450). Statistical analysis included the calculation of 5 % quantiles for defining reference values. RVOT-AT significantly but weakly correlated with age (r: −0.207; p < 0.001), body mass Index (r: −0.16), systolic (r: −0.158) and diastolic (r: −0.137) blood pressure, heart rate (r: −0.197) and left ventricular (LV) E/A ratio (r: 0.229) (all p < 0.001). No differences were found with regards to sex. In a synopsis of both prospective and literature-based data sets, RVOT-AT weighted means was 138.51 ms and the 5 % quantile was 104.7 ms (95 % confidence interval 98.2–110.1). This study delineates the range of RVOT-AT in healthy adults and it’s determining factors. Our study is in line with the cut-off value stated by the European guidelines with an RVOT-AT ≤105 ms denoting abnormal values.

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References

  1. Bossone E, D’Andrea A, D’Alto M, Citro R, Argiento P, Ferrara F, Cittadini A, Rubenfire M, Naeije R (2013) Echocardiography in pulmonary arterial hypertension: from diagnosis to prognosis. J Am Soc Echocardiogr 26:1–14. doi:10.1016/j.echo.2012.10.009

    Article  PubMed  Google Scholar 

  2. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685-713. doi:10.1016/j.echo.2010.05.010

    Article  Google Scholar 

  3. Kitabatake A, Inoue M, Asao M, Masuyama T, Tanouchi J, Morita T, Mishima M, Uematsu M, Shimazu T, Hori M, Abe H (1983) Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique. Circulation 68:302–309. http://www.ncbi.nlm.nih.gov/pubmed/6861308. Accessed 10 Aug 2015

  4. Dabestani A, Mahan G, Gardin JM, Takenaka K, Burn C, Allfie A, Henry WL (1987) Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography. Am J Cardiol 59:662–668. http://www.ncbi.nlm.nih.gov/pubmed/3825910. Accessed 10 Aug 2015

  5. Armstrong W (2010) Feigenbaum’s echocardiography. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  6. Galiè N, Humbert M, Vachiery J-L, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M (2015) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. doi:10.1093/eurheartj/ehv317.

    Google Scholar 

  7. Lau EMT, Manes A, Celermajer DS, Galiè N (2011) Early detection of pulmonary vascular disease in pulmonary arterial hypertension: time to move forward. Eur Heart J 32:2489–2498. doi:10.1093/eurheartj/ehr160

    Article  PubMed  Google Scholar 

  8. Yared K, Noseworthy P, Weyman AE, McCabe E, Picard MH, Baggish AL (2011) Pulmonary artery acceleration time provides an accurate estimate of systolic pulmonary arterial pressure during transthoracic echocardiography. J Am Soc Echocardiogr 24:687–692. doi:10.1016/j.echo.2011.03.008

    Article  PubMed  Google Scholar 

  9. Chan KL, Currie PJ, Seward JB, Hagler DJ, Mair DD, Tajik AJ (1987) Comparison of three Doppler ultrasound methods in the prediction of pulmonary artery pressure. J Am Coll Cardiol 9:549–554

    Article  CAS  PubMed  Google Scholar 

  10. Vriz O, Aboyans V, D’Andrea A, Ferrara F, Acri E, Limongelli G, Della Corte A, Driussi C, Bettio M, Pluchinotta FR, Citro R, Russo MG, Isselbacher E, Bossone E (2014) Normal values of aortic root dimensions in healthy adults. Am J Cardiol 114:921–927. doi:10.1016/j.amjcard.2014.06.028

    Article  PubMed  Google Scholar 

  11. Grünig E, Biskupek J, D’Andrea A, Ehlken N, Egenlauf B, Weidenhammer J, Marra AM, Cittadini A, Fischer C, Bossone E (2015) Reference ranges for and determinants of right ventricular area in healthy adults by two-dimensional echocardiography. Respiration 89:284–293. doi:10.1159/000371472

    Article  PubMed  Google Scholar 

  12. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt J-U (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39. doi:10.1016/j.echo.2014.10.003

    Article  PubMed  Google Scholar 

  13. Lindqvist P, Henein M, Kazzam E (2003) Right ventricular outflow-tract fractional shortening: an applicable measure of right ventricular systolic function. Eur J Echocardiogr 4:29–35

    Article  CAS  PubMed  Google Scholar 

  14. Pekdemir H, Camsari A, Akkus MN, Cicek D, Tuncer C, Yildirim Z (2003) Impaired cardiac autonomic functions in patients with environmental asbestos exposure: a study of time domain heart rate variability. J Electrocardiol 36:195–203

    Article  PubMed  Google Scholar 

  15. Lopez-Candales A, Eleswarapu A, Shaver J, Edelman K, Gulyasy B, Candales MD (2010) Right ventricular outflow tract spectral signal: a useful marker of right ventricular systolic performance and pulmonary hypertension severity. Eur J Echocardiogr 11:509–515. doi:10.1093/ejechocard/jeq009

    Article  PubMed  Google Scholar 

  16. Fukuda Y, Tanaka H, Sugiyama D, Ryo K, Onishi T, Fukuya H, Nogami M, Ohno Y, Emoto N, Kawai H, Hirata K-I (2011) Utility of right ventricular free wall speckle-tracking strain for evaluation of right ventricular performance in patients with pulmonary hypertension. J Am Soc Echocardiogr 24:1101–1108. doi:10.1016/j.echo.2011.06.005

    Article  PubMed  Google Scholar 

  17. Henein M, Waldenström A, Mörner S, Lindqvist P (2014) The normal impact of age and gender on right heart structure and function. Echocardiography 31:5–11. doi:10.1111/echo.12289

    Article  PubMed  Google Scholar 

  18. Geyik B, Tarakci N, Ozeke O, Ertan C, Gul M, Topaloglu S, Aras D, Demir AD, Tufekcioglu O, Golbasi Z, Aydogdu S (2015) Right ventricular outflow tract function in chronic obstructive pulmonary disease. Herz 40:624–628. doi:10.1007/s00059-013-3978-9

    Article  CAS  PubMed  Google Scholar 

  19. Ertan C, Tarakci N, Ozeke O, Demir AD (2013) Pulmonary artery distensibility in chronic obstructive pulmonary disease. Echocardiography 30:940–944. doi:10.1111/echo.12170

    Article  PubMed  Google Scholar 

  20. Vatan MB, Varım C, Ağaç MT, Varım P, Çakar MA, Aksoy M, Erkan H, Yılmaz S, Kilic H, Gündüz H, Akdemir R (2015) Echocardiographic evaluation of biventricular function in patients with Euthyroid Hashimoto’s Thyroiditis. Med Princ Pract. doi:10.1159/000442709.

    PubMed  Google Scholar 

  21. Coghlan JG, Denton CP, Grünig E, Bonderman D, Distler O, Khanna D, Müller-Ladner U, Pope JE, Vonk MC, Doelberg M, Chadha-Boreham H, Heinzl H, Rosenberg DM, McLaughlin VV, Seibold JR (2014) Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study. Ann Rheum Dis 73:1340–1349. doi:10.1136/annrheumdis-2013-203301

    Article  PubMed  Google Scholar 

  22. Humbert M, Yaici A, de Groote P, Montani D, Sitbon O, Launay D, Gressin V, Guillevin L, Clerson P, Simonneau G, Hachulla E (2011) Screening for pulmonary arterial hypertension in patients with systemic sclerosis: clinical characteristics at diagnosis and long-term survival. Arthritis Rheum 63:3522–3530. doi:10.1002/art.30541

    Article  PubMed  Google Scholar 

  23. Caturegli P, De Remigis A, Rose NR (2014) Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev 13:391–397. doi:10.1016/j.autrev.2014.01.007.

    Article  CAS  PubMed  Google Scholar 

  24. McQuillan BM, Picard MH, Leavitt M, Weyman AE (2001) Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation 104:2797–2802. doi:10.1161/hc4801.100076

    Article  CAS  PubMed  Google Scholar 

  25. Lam CSP, Borlaug BA, Kane GC, Enders FT, Rodeheffer RJ, Redfield MM (2009) Age-associated increases in pulmonary artery systolic pressure in the general population. Circulation 119:2663–2670. doi:10.1161/CIRCULATIONAHA.108.838698

    Article  PubMed  PubMed Central  Google Scholar 

  26. D’Andrea A, Naeije R, Grünig E, Caso P, D’Alto M, Di Palma E, Nunziata L, Riegler L, Scarafile R, Cocchia R, Vriz O, Citro R, Calabrò R, Russo MG, Bossone E (2014) Echocardiography of the pulmonary circulation and right ventricular function: exploring the physiologic spectrum in 1480 normal subjects. Chest 145:1071–1078. doi:10.1378/chest.12-3079

    Article  PubMed  Google Scholar 

  27. Hatle L, Angelsen BA, Tromsdal A (1981) Non-invasive estimation of pulmonary artery systolic pressure with Doppler ultrasound. Br Heart J 45:157–165

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Naeije R, Torbicki A (1995) More on the noninvasive diagnosis of pulmonary hypertension: Doppler echocardiography revisited. Eur Respir J 8:1445–1449

    CAS  PubMed  Google Scholar 

  29. Mallery JA, Gardin JM, King SW, Ey S, Henry WL (1991) Effects of heart rate and pulmonary artery pressure on Doppler pulmonary artery acceleration time in experimental acute pulmonary hypertension. Chest 100:470–473

    Article  CAS  PubMed  Google Scholar 

  30. Oktay AA, Shah SJ (2014) Current perspectives on systemic hypertension in heart failure with preserved ejection fraction. Curr Cardiol Rep 16:545. doi:10.1007/s11886-014-0545-9.

    Article  PubMed  Google Scholar 

  31. Rosenkranz S, Gibbs JSR, Wachter R, De Marco T, Vonk-Noordegraaf A, Vachiéry J-L (2016) Left ventricular heart failure and pulmonary hypertension. Eur Heart J 37:942–54. doi:10.1093/eurheartj/ehv512.

    Article  PubMed  Google Scholar 

  32. Lam CSP, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM (2009) Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol 53:1119–1126. doi:10.1016/j.jacc.2008.11.051

    Article  PubMed  PubMed Central  Google Scholar 

  33. Marra AM, Improda N, Capalbo D, Salzano A, Arcopinto M, De Paulis A, Alessio M, Lenzi A, Isidori AM, Cittadini A, Salerno M (2015) Cardiovascular abnormalities and impaired exercise performance in adolescents with congenital adrenal hyperplasia. J Clin Endocrinol Metab 100:644–652. doi:10.1210/jc.2014-1805

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. IRCCS S.D.N., Via Gianturco 113, 80143, Naples, Italy

    Alberto M. Marra

  2. Pulmonary Hypertension Center, Thoraxclinic at University of Heidelberg, Heidelberg, Germany

    Nicola Benjamin & Ekkehard Grünig

  3. Department of Cardiology and Cardiac Surgery, University Hospital “Scuola Medica Salernitana”, Salerno, Italy

    Francesco Ferrara & Eduardo Bossone

  4. Department of Emergency and Cardiology, “S. Antonio” Community Hospital, San Daniele del Friuli, UD, Italy

    Olga Vriz

  5. Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy

    Michele D’Alto & Antonello D’Andrea

  6. Department of Respiratory Diseases, Monaldi Hospital, University Federico II, Naples, Italy

    Anna Agnese Stanziola

  7. Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Luna Gargani

  8. Department of Translational Medical Sciences, Federico II University, Naples, Italy

    Antonio Cittadini

  9. Cardiology Division, “Cava de’ Tirreni and Amalfi Coast” Hospital, Heart Department, University of Salerno – Italy, Via Pr. Amedeo, 36, 83023, Lauro, AV, Italy

    Eduardo Bossone

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  1. Alberto M. Marra
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Correspondence to Eduardo Bossone.

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Marra, A.M., Benjamin, N., Ferrara, F. et al. Reference ranges and determinants of right ventricle outflow tract acceleration time in healthy adults by two-dimensional echocardiography. Int J Cardiovasc Imaging 33, 219–226 (2017). https://doi.org/10.1007/s10554-016-0991-0

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