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THE NORMAL RESPONSE OF ESTIMATED RIGHT VENTRICULAR SYSTOLIC PRESSURE DURING EXERCISE AND DOBUTAMINE STRESS ECHO

THE NORMAL RESPONSE OF ESTIMATED RIGHT VENTRICULAR SYSTOLIC PRESSURE DURING EXERCISE AND DOBUTAMINE STRESS ECHO


Author Block: MF Matangi, DW Armstrong, AK Peirce, JA Courneya, M MacKenzie
Kingston, Ontario

Abstract:
PURPOSE. The aim of our investigation was to determine the normal change in estimated right ventricular systolic pressure (RVSP) during exercise (Ex) and dobutamine (Dob) stress echocardiography (ECHO) in a series of consecutive patients (P) referred for stress ECHO.
METHODS. Only P with a completely normal Ex or Dob ECHO were used in this analysis. The tricuspid regurgitant jet was recorded at rest and following completion of the stress images. A mean right atrial pressure of 10mmHg was used in the calculation of RVSP. Only P with analyzable rest and post stress tricuspid regurgitant jets were used in this analysis. All data were entered into CARDIOfile, a cardiology database for later retrieval and analysis. Colour doppler is not performed during stress ECHO. To exclude the possibility of significant mitral regurgitation increasing the RVSP with stress the data were reanalyzed using only P with a normal left atrium size of <41mm by m-mode measurement.
RESULTS. 364 P underwent Ex or Dob stress ECHO between January 8, 2008 and March 28, 2008. 83 P had either the resting or peak or both RVSPs missing and were excluded. Of the remaining 281 P, 48 P had abnormal wall motion either at rest, post stress or both and were also excluded. The remaining 233 P with no wall motion abnormalities at rest or following stress make up the study population. There were 172 normal Ex ECHO and 61 normal Dob ECHO. The RVSP mean results are shown in table 1.

Table 1.
  Rest RVSP (mmHg) Peak RVSP (mmHg) Age (yrs)
Ex ECHO (n=172) 26.6 +/-7.3 33.7 +/-10.8 58.4 +/-11.9*
Ex ECHO LA normal (n=141) 26.3 +/-7.2 33.3 +/-10.8  
Dob ECHO (n=62) 29.5 +/-8.9 44.2 +/-13.0 66.2 +/-11.6*
Dob ECHO LA normal (n=43) 29.2 +/-9.0 43.4 +/-12.4  


CONCLUSIONS. For Ex ECHO the RVSP should not increase by more than 22mmHg above the resting value and should not exceed 55mmHg. If either of these criteria is met then the response is considered abnormal. For Dob ECHO the RVSP should not increase by more than 26mmHg above the resting value and should not exceed 70mmHg. If either of these criteria is met then the response is considered abnormal. Reanalysis with normal LA size did not change the results. The different resting mean values for RVSP between Ex and Dob ECHO could simply be related to age (*p