Right Heart International NETwork During Exercise in Different Clinical Conditions

Study Overview
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Brief Summary
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The aim of this registry will be to compare the pathophysiological response of the morphology and function of the right heart and pulmonary circulation assessed with resting and stress-echocardiography in patients with various cardiovascular diseases, to compare them to healthy individuals. The physiological response in healthy individuals as well as elite athletes, defined as athletes participating at national and international competitions, will also be evaluated. Patients will be enrolled both prospectively as well as retrospectively and the will be evaluated by resting and stress echocardiography, which are part of the routine clinical practice. All clinical outcome measures will be collected as part of routine examinations. The measurements will include systolic and diastolic pump function of the right and left ventricles and other echocardiographic parameters. Moreover, a comparison of these parameters among different groups will be performed. Other optional assessments will include: exercise capacity assessed with 6-minute walking distance, World Health Organization functional class (WHO functional class), peak oxygen uptake assessed by spiroergometry. Patients will be evaluated at baseline and each year with the aforementioned procedures according to the sites clinical routine.

Detailed Description
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Patients will be evaluated with a routinely performed resting and stress echocardiography. Moreover, physical examination and ECG will be performed and past medical history will be collected. Optional procedures comprise of quality of life assessment (SF-36 questionnaire), six minute walking distance (6MWD), cardiopulmonary exercise testing (CPET), routine laboratory including biochemical work-up. Comparison among different cohorts of patients with regards to right heart morphology and function at rest, assessed during a routinely performed resting and stress echography. The following parameters will be evaluated: Right ventricular (RV) diameters RV free wall thickness End-diastolic and end-systolic left ventricular volumes and ejection fraction Right atrial (RA) area End-diastolic and end-systolic RV area and % shortening of the areas of the right ventricle Tricuspid regurgitation velocity (TRV) and severity Tricuspid annular plane systolic excursion (TAPSE) Inferior vena cava diameter and % of collapsibility TAPSE at peak exercise and after 5 minutes recovery TRV at peak exercise and after 5 minutes recovery RV end-diastolic and end-systolic area and % shortening of the areas at peak exercise and after 5 minutes recovery RA area at peak exercise and after 5 minutes recovery Left ventricular end-diastolic and end-systolic volume and ejection fraction at peak exercise and after 5 minutes recovery Left ventricular eccentricity index at peak exercise and after 5 minutes recovery

Official Title
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Morphological and Functional Response of the Right Heart and Pulmonary Circulation

Conditions
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Right Ventricular Dysfunction

Intervention / Treatment
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* Diagnostic Test: stress echocardiography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Written informed consent Males and females ≥ 18 years' old Ability to understand study-specific design and procedures and provide informed consent to the study Exclusion Criteria: Inability to perform exercise stress test Active smoker Pregnancy and/or lactation Active malignancy End-stage renal disease requiring dialysis

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Healthy subjects<br>Cohort of patients referred to our echocardiography laboratory to work assessment procedures and without any cardiovascular risk factor. They will underwent stress echocardiography. | Diagnostic Test: stress echocardiography<br>* stress echocardiography will be performed in accordance with the current guidelines on a variable load 45° cycle ergometer with an incremental workload of 25 W every 2 minutes up to the symptom-limited maximal tolerated workload. Echocardiographic measurements will be acquired at baseline, at peak exercise and during recovery of 5 minutes. The electrocardiogram and blood pressure will be monitored at each workload. Termination criteria and / or positive test criteria for inducible myocardial ischemia will follow the current recommendations<br>|
| cardio-respiratory diseases<br>patients with any possible cardiovascular and respiratory condition. They will underwent stress echocardiography. | Diagnostic Test: stress echocardiography<br>* stress echocardiography will be performed in accordance with the current guidelines on a variable load 45° cycle ergometer with an incremental workload of 25 W every 2 minutes up to the symptom-limited maximal tolerated workload. Echocardiographic measurements will be acquired at baseline, at peak exercise and during recovery of 5 minutes. The electrocardiogram and blood pressure will be monitored at each workload. Termination criteria and / or positive test criteria for inducible myocardial ischemia will follow the current recommendations<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Right Ventricle contractile reserve | Difference of tricuspid regurgitation velocity at rest to peak exercise (m/s) | ten years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| All-cause Mortality | All cause of mortality | ten years | 
| Cardiovascular Mortality | all cardiovascular mortality | ten years | 
| RV internal end-diastolic diameters | measurement of basal and midcavity RV internal end-diastolic diameters from the four-chamber view in mm | ten years | 
| tricuspid annular plane systolic excursion (TAPSE) | tricuspid annular plane systolic excursion (TAPSE) determined in M-mode in mm | ten years |