Document Detail


Pulmonary transit of agitated contrast is associated with enhanced pulmonary vascular reserve and right ventricular function during exercise.
MedLine Citation:
PMID:  20724567     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pulmonary transit of agitated contrast (PTAC) occurs to variable extents during exercise. We tested the hypothesis that the onset of PTAC signifies flow through larger-caliber vessels, resulting in improved pulmonary vascular reserve during exercise. Forty athletes and fifteen nonathletes performed maximal exercise with continuous echocardiographic Doppler measures [cardiac output (CO), pulmonary artery systolic pressure (PASP), and myocardial velocities] and invasive blood pressure (BP). Arterial gases and B-type natriuretic peptide (BNP) were measured at baseline and peak exercise. Pulmonary vascular resistance (PVR) was determined as the regression of PASP/CO and was compared according to athletic and PTAC status. At peak exercise, athletes had greater CO (16.0 ± 2.9 vs. 12.4 ± 3.2 l/min, P < 0.001) and higher PASP (60.8 ± 12.6 vs. 47.0 ± 6.5 mmHg, P < 0.001), but PVR was similar to nonathletes (P = 0.71). High PTAC (defined by contrast filling of the left ventricle) occurred in a similar proportion of athletes and nonathletes (18/40 vs. 10/15, P = 0.35) and was associated with higher peak-exercise CO (16.1 ± 3.4 vs. 13.9 ± 2.9 l/min, P = 0.010), lower PASP (52.3 ± 9.8 vs. 62.6 ± 13.7 mmHg, P = 0.003), and 37% lower PVR (P < 0.0001) relative to low PTAC. Right ventricular (RV) myocardial velocities increased more and BNP increased less in high vs. low PTAC subjects. On multivariate analysis, maximal oxygen consumption (VO(2max)) (P = 0.009) and maximal exercise output (P = 0.049) were greater in high PTAC subjects. An exercise-induced decrease in arterial oxygen saturation (98.0 ± 0.4 vs. 96.7 ± 1.4%, P < 0.0001) was not influenced by PTAC status (P = 0.96). Increased PTAC during exercise is a marker of pulmonary vascular reserve reflected by greater flow, reduced PVR, and enhanced RV function.
Authors:
André La Gerche; Andrew I MacIsaac; Andrew T Burns; Don J Mooney; Warrick J Inder; Jens-Uwe Voigt; Hein Heidbüchel; David L Prior
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Video-Audio Media     Date:  2010-08-19
Journal Detail:
Title:  Journal of applied physiology (Bethesda, Md. : 1985)     Volume:  109     ISSN:  1522-1601     ISO Abbreviation:  J. Appl. Physiol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-09     Completed Date:  2011-02-18     Revised Date:  2013-09-26    
Medline Journal Info:
Nlm Unique ID:  8502536     Medline TA:  J Appl Physiol (1985)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1307-17     Citation Subset:  IM    
Affiliation:
Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia. Andre.LaGerche@svhm.org.au
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MeSH Terms
Descriptor/Qualifier:
Adaptation, Physiological
Adult
Biological Markers / blood
Blood Pressure
Cardiac Output
Contrast Media / diagnostic use*,  metabolism
Echocardiography, Doppler*
Echocardiography, Doppler, Color
Echocardiography, Doppler, Pulsed
Exercise*
Gelatin / blood,  diagnostic use*
Heart Ventricles / ultrasonography*
Hemodynamics*
Humans
Lung / blood supply*
Microbubbles
Myocardial Contraction
Natriuretic Peptide, Brain / blood
Oxygen / blood
Oxygen Consumption
Partial Pressure
Physical Endurance
Predictive Value of Tests
Pulmonary Circulation*
Succinates / blood,  diagnostic use*
Vascular Resistance
Ventricular Function, Right*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Contrast Media; 0/Succinates; 114471-18-0/Natriuretic Peptide, Brain; 39340-57-3/succinylated gelatin; 7782-44-7/Oxygen; 9000-70-8/Gelatin
Comments/Corrections
Comment In:
J Appl Physiol (1985). 2010 Nov;109(5):1290-1   [PMID:  20847135 ]

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