Measurement of pulmonary transit time and estimation of pulmonary blood volume after exercise using contrast echocardiography.

Abstract

Pulmonary transit time (PTT) and pulmonary blood volume (PBV) derived from non-invasive imaging correlate with pulmonary artery wedge pressure. The response of PBV to exercise may be useful in the evaluation of cardiopulmonary disease but whether PBV can be obtained reliably following exercise is unknown. We therefore aimed to assess the technical feasibility of measuring PTT and PBV after exercise using contrast echocardiography. In healthy volunteers, PTT was calculated from time-intensity curves generated as contrast traversed the cardiac chambers before and immediately after participants performed sub-maximal exercise on the Standard Bruce Protocol. From the product of PTT and heart rate (HR) during contrast passage through the pulmonary circulation, PBV relative to systemic stroke volume (rPBV) was calculated. The cohort consisted of 14 individuals (age: 46 ± 8years; 2 female) without cardiopulmonary disease. Exercise time was 8 ¾ ± 1 ¾ minutes and participants reached 85 ± 9% of age-predicted maximal HR, which corresponded to a near-doubling of resting HR at the time of post-exercise contrast injection. Data sufficient to derive PTT and rPBV were obtained for all participants. With exercise, the change in PBV from baseline ranged from 56 to 138% of systemic stroke volume, consistent with rPBV and absolute PBV values obtained in prior studies. Acquisition of PTT and rPBV using contrast echocardiography after exercise is achievable and the results are physiologically plausible. As the next step towards clinical implementation, validation of this technique against hemodynamic exercise studies appears reasonable.