Right ventricular and pulmonary vascular function are influenced by age and volume expansion in healthy humans

BACKGROUND: Patients with heart failure (HF) often show signs of RV dysfunction. The function of RV coupled with the pulmonary circulation (tricuspid annular plane systolic excursion [TAPSE]: pulmonary artery systolic pressure [PASP]) has been shown to divide HF patients into distinct prognostic strata, however less is known about which factors influence this prognostic marker, and whether these factors can be modified. We sought to obtain normative values and discern the individual effects of age, gender, and fluid overload on right ventricular (RV) function.

METHODS: Sixty healthy subjects aged 20-80 years were enrolled in this prospective study. Right heart catheterization with hemodynamic measurements were performed at rest and following a rapid saline infusion (10 ml/kg, 150 ml/min). Linear regression and Spearman correlation models were used to estimate associations between TAPSE:PASP and relevant variables.

RESULTS: In healthy persons of all ages, the normative TASPE:PASP ratio was median (5th-95th percentile) 1.25 (0.81-1.78) mm/mmHg. The correlation between progressive age and declining TAPSE:PASP was significant (r: -0.35, p=0.006). Gender did not influence TAPSE:PASP (p=0.30). Rapid fluid expansion increased central venous pressure from 5 ± 2 mmHg to 11 ± 4 mmHg after fluid infusion (p<0.0001). This resulted in a 32% decrease in the TAPSE:PASP ratio after fluid infusion, compared to baseline (p<0.0001).

CONCLUSIONS: The TAPSE:PASP ratio was affected by age, but not gender.

TAPSE: PASP is not only a reflection of intrinsic RV function and pulmonary vascular coupling, but fluid status dynamically affects this index of RV function. Normative values with invasive measurements were obtained for future assessment of HF patients.