Impact of age on pulmonary artery systolic pressures at rest and with exercise
Echo Research & Practice volume 3, pages 53–61 (2016)
Aim: It is not well known if advancing age influences normal rest or exercise pulmonary artery pressures. The purpose of the study was to evaluate the association of increasing age with measurements of pulmonary artery systolic pressure at rest and with exercise.
Subjects and methods: A total of 467 adults without cardiopulmonary disease and normal exercise capacity (age range: 18–85 years) underwent symptom-limited treadmill exercise testing with Doppler measurement of rest and exercise pulmonary artery systolic pressure.
Results: There was a progressive increase in rest and exercise pulmonary artery pressures with increasing age. Pulmonary artery systolic pressures at rest and with exercise were 25±5mmHg and 33±9mmHg, respectively, in those <40 years, and 30±5mmHg and 41±12mmHg, respectively, in those ≥70 years. While elevated left-sided cardiac filling pressures were excluded by protocol design, markers of arterial stiffness associated with the age-dependent effects on pulmonary pressures.
Conclusion: These data demonstrate that in echocardiographically normal adults, pulmonary artery systolic pressure increases with advancing age. This increase is seen at rest and with exercise. These increases in pulmonary pressure occur in association with decreasing transpulmonary flow and increases in systemic pulse pressure, suggesting that age-associated blood vessel stiffening may contribute to these differences in pulmonary artery systolic pressure.
Maréchaux S, Pinçon C, Le Tourneau T, de Groote P, Huerre C, Asseman P, Van Belle E, Nevière R, Bauters C, Deklunder G, et al. 2008 Cardiac correlates of exercise induced pulmonary hypertension in patients with chronic heart failure due to left ventricular systolic dysfunction. Echocardiography 25 386–393. (doi:10.1111/j.1540-8175.2007.00616.x)
Steen V, Chou M, Shanmugam V, Mathias M, Kuru T & Morrissey R 2008 Exercise-induced pulmonary arterial hypertension in patients with systemic sclerosis. Chest 134 146–151. (doi:10.1378/chest.07-2324)
Himelman RB, Stulbarg M, Kircher B, Lee E, Kee L, Dean NC, Golden J, Wolfe CL & Schiller NB 1989 Noninvasive evaluation of pulmonary artery pressure during exercise by saline-enhanced Doppler echocardiography in chronic pulmonary disease. Circulation 79 863–871. (doi:10.1161/01.CIR.79.4.863)
Grünig E, Janssen B, Mereles D, Barth U, Borst MM, Vogt IR, Fischer C, Olschewski H, Kuecherer HF & Kübler W 2000 Abnormal pulmonary artery pressure response in asymptomatic carriers of primary pulmonary hypertension gene. Circulation 102 1145–1150. (doi:10.1161/01.CIR.102.10.1145)
Oelberg DA, Marcotte F, Kreisman H, Wolkove N, Langleben D & Small D 1998 Evaluation of right ventricular systolic pressure during incremental exercise by Doppler echocardiography in adults with atrial septal defect. Chest 113 1459–1465. (doi:10.1378/chest.113.6.1459)
Grünig E, Weissmann S, Ehlken N, Fijalkowska A, Fischer C, Fourme T, Galié N, Ghofrani A, Harrison RE, Huez S, et al. 2009 Stress Doppler echocardiography in relatives of patients with idiopathic and familial pulmonary arterial hypertension: results of a multicenter European analysis of pulmonary artery pressure response to exercise and hypoxia. Circulation 119 1747–1757. (doi:10.1161/CIRCULATIONAHA.108.800938)
Badesch DB, Champion HC, Sanchez MA, Hoeper MM, Loyd JE, Manes A, McGoon M, Naeije R, Olschewski H, Oudiz RJ, et al. 2009 Diagnosis and assessment of pulmonary arterial hypertension. Journal of the American College of Cardiology 54 S55–S66.
McGoon MD & Kane GC 2009 Pulmonary hypertension: diagnosis and management. Mayo Clinic Proceedings 84 191–207. (doi:10.4065/84.2.191)
Bossone E, Rubenfire M, Bach DS, Ricciardi M & Armstrong WF 1999 Range of tricuspid regurgitation velocity at rest and during exercise in normal adult men: implications for the diagnosis of pulmonary hypertension. Journal of the American College of Cardiology 33 1662–1666. (doi:10.1016/S0735-1097(99)00055-8)
Lam CS, Borlaug BA, Kane GC, Enders FT, Rodeheffer RJ & Redfield MM 2009 Age-associated increases in pulmonary artery systolic pressure in the general population. Circulation 119 2663–2670. (doi:10.1161/CIRCULATIONAHA.108.838698)
Kovacs G, Berghold A, Scheidl S & Olschewski H 2009 Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review. European Respiratory Journal 34 888–894. (doi:10.1183/09031936.00145608)
Ehrsam RE, Perruchoud A, Oberholzer M, Burkart F & Herzog H 1983 Influence of age on pulmonary haemodynamics at rest and during supine exercise. Clinical Science 65 653–660. (doi:10.1042/cs0650653)
Grewal J, McCully RB, Kane GC, Lam C & Pellikka PA 2009 Left ventricular function and exercise capacity. JAMA 301 286–294. (doi:10.1001/jama.2008.1022)
Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, Vasan RS & Levy D 2004 Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: the Framingham Heart Study. Hypertension 43 1239–1245. (doi:10.1161/01.HYP.0000128420.01881.aa)
Kelly R, Hayward C, Avolio A & O’Rourke M 1989 Noninvasive determination of age-related changes in the human arterial pulse. Circulation 80 1652–1659. (doi:10.1161/01.CIR.80.6.1652)
Kane GC, Hepinstall MJ, Kidd GM, Kuehl CA, Murphy AT, Nelson JM, Schneider L, Stussy VL, Warmsbecker JA, Miller FA Jr, et al. 2008 Safety of stress echocardiography supervised by registered nurses: results of a 2-year audit of 15,404 patients. Journal of the American Society of Echocardiography 21 337–341. (doi:10.1016/j.echo.2007.08.028)
Quinones MA, Waggoner AD, Reduto LA, Nelson JG, Young JB & Winters WL Jr, Ribeiro LG, Miller RR 1981 A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography. Circulation 64 744–753. (doi:10.1161/01.CIR.64.4.744)
Dittmann H, Voelker W, Karsch KR & Seipel L 1987 Influence of sampling site and flow area on cardiac output measurements by Doppler echocardiography. Journal of the American College of Cardiology 10 818–823. (doi:10.1016/S0735-1097(87)80275-9)
Chan KL, Currie PJ, Seward JB, Hagler DJ, Mair DD & Tajik AJ 1987 Comparison of three Doppler ultrasound methods in the prediction of pulmonary artery pressure. Journal of the American College of Cardiology 9 549–554. (doi:10.1016/S0735-1097(87)80047-5)
Currie PJ, Seward JB, Chan KL, Fyfe DA, Hagler DJ, Mair DD, Reeder GS, Nishimura RA & Tajik AJ 1985 Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients. Journal of the American College of Cardiology 6 750–756. (doi:10.1016/S0735-1097(85)80477-0)
Yock PG & Popp RL 1984 Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 70 657–662. (doi:10.1161/01.CIR.70.4.657)
Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM & Tajik AJ 2000 Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102 1788–1794. (doi:10.1161/01.CIR.102.15.1788)
Burgess MI, Jenkins C & Sharman JE, Marwick TH 2006 Diastolic stress echocardiography: hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise. Journal of the American College of Cardiology 47 1891–1900. (doi:10.1016/j.jacc.2006.02.042)
Tsang TS, Barnes ME, Gersh BJ & Bailey KR, Seward JB 2002 Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. American Journal of Cardiology 90 1284–1289. (doi:10.1016/S0002-9149(02)02864-3)
Majoub H, Levy F, Cassol M, Meimoun P, Peltier M, Rusinaru D& Tribouilloy C 2009 Effects of age on pulmonary artert systolic pressure at rest and during exercise in normal adults. European Journal of Echocardiography 10 635–640. (doi:10.1093/ejechocard/jep024)
Ha JW, Choi D, Park S, Shim CY, Kim JM, Moon SH, Lee HJ, Choi EY& Chung N 2009 Determinants of exercise-induced pulmonary hypertension in patients with normal left ventricular ejection fraction. Heart 95 490–494. (doi:10.1136/hrt.2007.139295)
Stanek V, Widimsky J & Hurych J 1969 The effect of age on the pressure-flow relationship and on the capacity of the pulmonary vascular bed with special reference to the condition of high flow. Progress in Respiration Research 5 375–38. (doi:10.1159/000391578)
Emirgil C, Sobol BJ, Campodonico S, Herbert WH & Mechkati R 1967 Pulmonary circulation in the aged. Journal of Applied Physiology 23 631–640.
Granath A, Jonsson B & Strandell T 1964 Circulation in healthy old men, studied by right heart catheterization at rest and during exercise in supine and sitting position. Acta Medica Scandinavica 176 425–446. (doi:10.1111/j.0954-6820.1964.tb00949.x)
Davidson WR Jr & Fee EC 1990 Influence of aging on pulmonary hemodynamics in a population free of coronary artery disease. American Journal of Cardiology 65 1454–1458. (doi:10.1016/0002-9149(90)91354-9)
McQuillan BM, Picard MH, Leavitt M & Weyman AE 2001 Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation 104 2797–2802. (doi:10.1161/hc4801.100076)
Van de Veire NR, De Backer J, Ascoop AK, Middernacht B, Velghe A & Sutter JD 2006 Echocardiographically estimated left ventricular end-diastolic and right ventricular systolic pressure in normotensive healthy individuals. International Journal of Cardiovascular Imaging 22 633–641. (doi:10.1007/s10554-006-9082-y)
Dib JC, Abergel E, Rovani C, Raffoul H & Diebold B 1997 The age of the patient should be taken into account when interpreting Doppler assessed pulmonary artery pressures. Journal of the American Society of Echocardiography 10 72–73. (doi:10.1016/S0894-7317(97)80035-1)
Mahapatra S, Nishimura RA, Sorajja P, Cha S & McGoon MD 2006 Relationship of pulmonary arterial capacitance and mortality in idiopathic pulmonary arterial hypertension. Journal of the American College of Cardiology 47 799–803. (doi:10.1016/j.jacc.2005.09.054)
Abbas AE, Fortuin FD, Schiller NB, Appleton CP, Moreno CA & Lester SJ 2003 A simple measure for noninvasive estimation of pulmonary vascular resistance. Journal of the American College of Cardiology 41 1021–1027. (doi:10.1016/S0735-1097(02)02973-X)
Mahapatra S, Nishimura RA, Oh JK & McGoon MD 2006 The prognostic value of pulmonary vascular capacitance determined by Doppler echocardiography in patients with pulmonary arterial hypertension Journal of the American Society of Echocardiography 19 1045–1050. (doi:10.1016/j.echo.2006.03.008)
Andersen MJ, Ersbøll M, Bro-Jeppesen J, Gustafsson F, Hassager C, Køber L, Borlaug BA, Boesgaard S, Kjærgaard J & Møller JE 2012 Exercise hemodynamics in patients with and without diastolic dysfunction and preserved ejection fraction after myocardial infarction. Exercise hemodynamics in patients with and without diastolic dysfunction and preserved ejection fraction after myocardial infarction. Circulation. Heart Failure 5 444–451. (doi:10.1161/CIRCHEARTFAILURE.112.967919)
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Kane, G.C., Sachdev, A., Villarraga, H.R. et al. Impact of age on pulmonary artery systolic pressures at rest and with exercise. Echo Res Pract 3, 53–61 (2016). https://doi.org/10.1530/ERP-16-0006