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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.
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:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Healthy subjects | Cohort of patients referred to our echocardiography laboratory to work assessment procedures and without any cardiovascular risk factor. They will underwent stress echocardiography. |
| |
| cardio-respiratory diseases | patients with any possible cardiovascular and respiratory condition. They will underwent stress echocardiography. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| stress echocardiography | Diagnostic Test | 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 |
| Measure | Description | Time Frame |
|---|---|---|
| Right Ventricle contractile reserve | Difference of tricuspid regurgitation velocity at rest to peak exercise (m/s) | ten years |
| Measure | Description | Time Frame |
|---|---|---|
| All-cause Mortality | All cause of mortality | ten years |
| Cardiovascular Mortality | all cardiovascular mortality | ten years |
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Inclusion Criteria:
Exclusion Criteria:
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Patients and healthy subjects will be enrolled both retrospectively as well as prospectively.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Eduardo Bossone, Chief of Cardiology | Contact | +390899926241 | ebossone@hotmail.com | |
| Alberto M. Marra, MD | Contact | +4915207559254 | alberto.marra@med.uni-heidelberg.de |
| Name | Affiliation | Role |
|---|---|---|
| Eduardo Bossone | Azienda Universitaria Ospedaliera "S. Giovanni e Ruggi d'Aragona" | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cardiology and Coronary Care Unit | Recruiting | Cava de' Tirreni | Salerno | 84019 | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40543748 | Derived | De Luca M, Ferrara F, Gargani L, Argiento P, Bandera F, Carbone A, Castaldo R, D'Agostino A, D'Alto M, D'Andrea A, D'Assante R, Franzese M, Giardino F, Grunig E, Kasprzak JD, Limongelli G, Passaro E, Pugliese NR, Rega S, Schiavo A, Vriz O, Wierzbowska-Drabik K, Cittadini A, Naeije R, Bossone E, Marra AM; RIGHT Heart International NETwork. Exercise Doppler Echocardiography of the Right Heart and Pulmonary Circulation in Patients With Cardiovascular Risk Factors: Observations From the RIGHT Heart International NETwork (RIGHT-NET). Chest. 2025 Dec;168(6):1460-1470. doi: 10.1016/j.chest.2025.06.020. Epub 2025 Jun 19. | |
| 37968015 |
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| ID | Term |
|---|---|
| D018497 | Ventricular Dysfunction, Right |
| ID | Term |
|---|---|
| D018754 | Ventricular Dysfunction |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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| ID | Term |
|---|---|
| D025401 | Echocardiography, Stress |
| ID | Term |
|---|---|
| D004452 | Echocardiography |
| D057791 | Cardiac Imaging Techniques |
| D003952 | Diagnostic Imaging |
| D019937 | Diagnostic Techniques and Procedures |
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|
| 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 |
| Derived |
| Gargani L, Pugliese NR, De Biase N, Mazzola M, Agoston G, Arcopinto M, Argiento P, Armstrong WF, Bandera F, Cademartiri F, Carbone A, Castaldo R, Citro R, Cocchia R, Codullo V, D'Alto M, D'Andrea A, Douschan P, Fabiani I, Ferrara F, Franzese M, Frumento P, Ghio S, Grunig E, Guazzi M, Kasprzak JD, Kolias T, Kovacs G, La Gerche A, Limogelli G, Marra AM, Matucci-Cerinic M, Mauro C, Moreo A, Pratali L, Ranieri B, Rega S, Rudski L, Saggar R, Salzano A, Serra W, Stanziola AA, Vannan MA, Voilliot D, Vriz O, Wierzbowska-Drabik K, Cittadini A, Naeije R, Bossone E; RIGHT Heart International NETwork (RIGHT-NET) Investigators. Exercise Stress Echocardiography of the Right Ventricle and Pulmonary Circulation. J Am Coll Cardiol. 2023 Nov 21;82(21):1973-1985. doi: 10.1016/j.jacc.2023.09.807. |
| D003933 | Diagnosis |
| D014463 | Ultrasonography |
| D006334 | Heart Function Tests |
| D003935 | Diagnostic Techniques, Cardiovascular |