Right Ventricular and Pulmonary Vascular Function are Influenced by Age and Volume Expansion in Healthy Humans

Emil Wolsk*, Rine Bakkestrøm, Charlotte Burup Kristensen, Katrine Aagaard Myhr, Jakob H. Thomsen, Louise Balling, Mads J. Andersen, Jordi S. Dahl, Sanjiv J. Shah, Finn Gustafsson, Christian Hassager, Jacob E. Møller

*Corresponding author for this work

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Abstract

Background: Patients with heart failure (HF) often show signs of right ventricular (RV) dysfunction. The RV function of coupled with the pulmonary circulation (tricuspid annular plane systolic excursion [TAPSE]/pulmonary arterial systolic pressure [PASP]) has been shown to divide HF patients into distinct prognostic strata, but less is known about which factors influence this prognostic marker, and whether those factors can be modified. We sought to obtain normative values and discern the individual effects of age, sex, and fluid overload on RV function. Methods and Results: Sixty healthy subjects aged 20–80 years were enrolled in this prospective study. Right heart catheterization with hemodynamic measurements were performed at rest after a rapid saline solution infusion (10 mL/kg, 150 mL/min). Linear regression and Spearman correlation models were used to estimate associations between TAPSE/PASP and relevant variables. In healthy persons of all ages, the median (5th–95th percentiles) normative TASPE-PASP ratio was 1.25 (0.81–1.78) mm/mm Hg. The correlation between progressive age and declining TAPSE/PASP was significant (r = −0.35; P =.006). Sex did not influence TAPSE/PASP (P =.30). Rapid fluid expansion increased central venous pressure from 5 ± 2 mm Hg to 11 ± 4 mm Hg after fluid infusion (P <.0001). This resulted in a 32% decrease in the TAPSE-PASP ratio after fluid infusion, compared to baseline (P <.0001). Conclusions: The TAPSE-PASP ratio was affected by age, but not sex. TAPSE/PASP is not only a reflection of intrinsic RV function and pulmonary vascular coupling, but fluid status also dynamically affects this index of RV function. Normative values with invasive measurements were obtained for future assessment of HF patients.

Original languageEnglish
JournalJournal of Cardiac Failure
Volume25
Issue number1
Pages (from-to)51-59
ISSN1071-9164
DOIs
Publication statusPublished - Jan 2019

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Arterial Pressure
Lung
Right Ventricular Function
Right Ventricular Dysfunction
Central Venous Pressure
Pulmonary Circulation
Linear Models
Prospective Studies

Keywords

  • age
  • fluid bolus
  • healthy
  • Heart failure
  • hemodynamics
  • right heart function
  • sex
  • TAPSE/PASP
  • Blood Volume/physiology
  • Blood Pressure/physiology
  • Prospective Studies
  • Pulmonary Artery/diagnostic imaging
  • Ventricular Function, Right/physiology
  • Cardiac Catheterization/trends
  • Humans
  • Middle Aged
  • Male
  • Stroke Volume/physiology
  • Aging/pathology
  • Young Adult
  • Aged, 80 and over
  • Adult
  • Female
  • Aged

Cite this

Wolsk, Emil ; Bakkestrøm, Rine ; Kristensen, Charlotte Burup ; Aagaard Myhr, Katrine ; Thomsen, Jakob H. ; Balling, Louise ; Andersen, Mads J. ; Dahl, Jordi S. ; Shah, Sanjiv J. ; Gustafsson, Finn ; Hassager, Christian ; Møller, Jacob E. / Right Ventricular and Pulmonary Vascular Function are Influenced by Age and Volume Expansion in Healthy Humans. In: Journal of Cardiac Failure. 2019 ; Vol. 25, No. 1. pp. 51-59.
@article{0726a31064a04d288a1dd1a451b6e682,
title = "Right Ventricular and Pulmonary Vascular Function are Influenced by Age and Volume Expansion in Healthy Humans",
abstract = "Background: Patients with heart failure (HF) often show signs of right ventricular (RV) dysfunction. The RV function of coupled with the pulmonary circulation (tricuspid annular plane systolic excursion [TAPSE]/pulmonary arterial systolic pressure [PASP]) has been shown to divide HF patients into distinct prognostic strata, but less is known about which factors influence this prognostic marker, and whether those factors can be modified. We sought to obtain normative values and discern the individual effects of age, sex, and fluid overload on RV function. Methods and Results: Sixty healthy subjects aged 20–80 years were enrolled in this prospective study. Right heart catheterization with hemodynamic measurements were performed at rest after a rapid saline solution infusion (10 mL/kg, 150 mL/min). Linear regression and Spearman correlation models were used to estimate associations between TAPSE/PASP and relevant variables. In healthy persons of all ages, the median (5th–95th percentiles) normative TASPE-PASP ratio was 1.25 (0.81–1.78) mm/mm Hg. The correlation between progressive age and declining TAPSE/PASP was significant (r = −0.35; P =.006). Sex did not influence TAPSE/PASP (P =.30). Rapid fluid expansion increased central venous pressure from 5 ± 2 mm Hg to 11 ± 4 mm Hg after fluid infusion (P <.0001). This resulted in a 32{\%} decrease in the TAPSE-PASP ratio after fluid infusion, compared to baseline (P <.0001). Conclusions: The TAPSE-PASP ratio was affected by age, but not sex. TAPSE/PASP is not only a reflection of intrinsic RV function and pulmonary vascular coupling, but fluid status also dynamically affects this index of RV function. Normative values with invasive measurements were obtained for future assessment of HF patients.",
keywords = "age, fluid bolus, healthy, Heart failure, hemodynamics, right heart function, sex, TAPSE/PASP, Blood Volume/physiology, Blood Pressure/physiology, Prospective Studies, Pulmonary Artery/diagnostic imaging, Ventricular Function, Right/physiology, Cardiac Catheterization/trends, Humans, Middle Aged, Male, Stroke Volume/physiology, Aging/pathology, Young Adult, Aged, 80 and over, Adult, Female, Aged",
author = "Emil Wolsk and Rine Bakkestr{\o}m and Kristensen, {Charlotte Burup} and {Aagaard Myhr}, Katrine and Thomsen, {Jakob H.} and Louise Balling and Andersen, {Mads J.} and Dahl, {Jordi S.} and Shah, {Sanjiv J.} and Finn Gustafsson and Christian Hassager and M{\o}ller, {Jacob E.}",
year = "2019",
month = "1",
doi = "10.1016/j.cardfail.2018.11.013",
language = "English",
volume = "25",
pages = "51--59",
journal = "Journal of Cardiac Failure",
issn = "1071-9164",
publisher = "Churchill Livingstone",
number = "1",

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Wolsk, E, Bakkestrøm, R, Kristensen, CB, Aagaard Myhr, K, Thomsen, JH, Balling, L, Andersen, MJ, Dahl, JS, Shah, SJ, Gustafsson, F, Hassager, C & Møller, JE 2019, 'Right Ventricular and Pulmonary Vascular Function are Influenced by Age and Volume Expansion in Healthy Humans', Journal of Cardiac Failure, vol. 25, no. 1, pp. 51-59. https://doi.org/10.1016/j.cardfail.2018.11.013

Right Ventricular and Pulmonary Vascular Function are Influenced by Age and Volume Expansion in Healthy Humans. / Wolsk, Emil; Bakkestrøm, Rine; Kristensen, Charlotte Burup; Aagaard Myhr, Katrine; Thomsen, Jakob H.; Balling, Louise; Andersen, Mads J.; Dahl, Jordi S.; Shah, Sanjiv J.; Gustafsson, Finn; Hassager, Christian; Møller, Jacob E.

In: Journal of Cardiac Failure, Vol. 25, No. 1, 01.2019, p. 51-59.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Right Ventricular and Pulmonary Vascular Function are Influenced by Age and Volume Expansion in Healthy Humans

AU - Wolsk, Emil

AU - Bakkestrøm, Rine

AU - Kristensen, Charlotte Burup

AU - Aagaard Myhr, Katrine

AU - Thomsen, Jakob H.

AU - Balling, Louise

AU - Andersen, Mads J.

AU - Dahl, Jordi S.

AU - Shah, Sanjiv J.

AU - Gustafsson, Finn

AU - Hassager, Christian

AU - Møller, Jacob E.

PY - 2019/1

Y1 - 2019/1

N2 - Background: Patients with heart failure (HF) often show signs of right ventricular (RV) dysfunction. The RV function of coupled with the pulmonary circulation (tricuspid annular plane systolic excursion [TAPSE]/pulmonary arterial systolic pressure [PASP]) has been shown to divide HF patients into distinct prognostic strata, but less is known about which factors influence this prognostic marker, and whether those factors can be modified. We sought to obtain normative values and discern the individual effects of age, sex, and fluid overload on RV function. Methods and Results: Sixty healthy subjects aged 20–80 years were enrolled in this prospective study. Right heart catheterization with hemodynamic measurements were performed at rest after a rapid saline solution infusion (10 mL/kg, 150 mL/min). Linear regression and Spearman correlation models were used to estimate associations between TAPSE/PASP and relevant variables. In healthy persons of all ages, the median (5th–95th percentiles) normative TASPE-PASP ratio was 1.25 (0.81–1.78) mm/mm Hg. The correlation between progressive age and declining TAPSE/PASP was significant (r = −0.35; P =.006). Sex did not influence TAPSE/PASP (P =.30). Rapid fluid expansion increased central venous pressure from 5 ± 2 mm Hg to 11 ± 4 mm Hg after fluid infusion (P <.0001). This resulted in a 32% decrease in the TAPSE-PASP ratio after fluid infusion, compared to baseline (P <.0001). Conclusions: The TAPSE-PASP ratio was affected by age, but not sex. TAPSE/PASP is not only a reflection of intrinsic RV function and pulmonary vascular coupling, but fluid status also dynamically affects this index of RV function. Normative values with invasive measurements were obtained for future assessment of HF patients.

AB - Background: Patients with heart failure (HF) often show signs of right ventricular (RV) dysfunction. The RV function of coupled with the pulmonary circulation (tricuspid annular plane systolic excursion [TAPSE]/pulmonary arterial systolic pressure [PASP]) has been shown to divide HF patients into distinct prognostic strata, but less is known about which factors influence this prognostic marker, and whether those factors can be modified. We sought to obtain normative values and discern the individual effects of age, sex, and fluid overload on RV function. Methods and Results: Sixty healthy subjects aged 20–80 years were enrolled in this prospective study. Right heart catheterization with hemodynamic measurements were performed at rest after a rapid saline solution infusion (10 mL/kg, 150 mL/min). Linear regression and Spearman correlation models were used to estimate associations between TAPSE/PASP and relevant variables. In healthy persons of all ages, the median (5th–95th percentiles) normative TASPE-PASP ratio was 1.25 (0.81–1.78) mm/mm Hg. The correlation between progressive age and declining TAPSE/PASP was significant (r = −0.35; P =.006). Sex did not influence TAPSE/PASP (P =.30). Rapid fluid expansion increased central venous pressure from 5 ± 2 mm Hg to 11 ± 4 mm Hg after fluid infusion (P <.0001). This resulted in a 32% decrease in the TAPSE-PASP ratio after fluid infusion, compared to baseline (P <.0001). Conclusions: The TAPSE-PASP ratio was affected by age, but not sex. TAPSE/PASP is not only a reflection of intrinsic RV function and pulmonary vascular coupling, but fluid status also dynamically affects this index of RV function. Normative values with invasive measurements were obtained for future assessment of HF patients.

KW - age

KW - fluid bolus

KW - healthy

KW - Heart failure

KW - hemodynamics

KW - right heart function

KW - sex

KW - TAPSE/PASP

KW - Blood Volume/physiology

KW - Blood Pressure/physiology

KW - Prospective Studies

KW - Pulmonary Artery/diagnostic imaging

KW - Ventricular Function, Right/physiology

KW - Cardiac Catheterization/trends

KW - Humans

KW - Middle Aged

KW - Male

KW - Stroke Volume/physiology

KW - Aging/pathology

KW - Young Adult

KW - Aged, 80 and over

KW - Adult

KW - Female

KW - Aged

U2 - 10.1016/j.cardfail.2018.11.013

DO - 10.1016/j.cardfail.2018.11.013

M3 - Journal article

C2 - 30472282

AN - SCOPUS:85059859767

VL - 25

SP - 51

EP - 59

JO - Journal of Cardiac Failure

JF - Journal of Cardiac Failure

SN - 1071-9164

IS - 1

ER -