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Exercise Doppler echocardiography provides established reference limits for RV-PA-LA unit measurements in healthy subjectsExercise tests provide clear standards for measuring heart health

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Key Takeaway
Use established ex-TTE reference limits to interpret RV-PA-LA unit measurements during exercise stress tests.

This meta-analysis evaluates the use of exercise Doppler echocardiography (ex-TTE) using a supine/semi-recumbent cycle ergometer to establish reference values in healthy subjects. The analysis included 1,122 participants and focused on the RV-PA-LA unit.

The synthesized results provide specific normal limits for several key metrics: tricuspid regurgitation velocity (TRV) of 2.5 m·s (ULN 3.4), systolic pulmonary artery pressure (sPAP) of 38.5 mmHg (ULN 57.8), and mean pulmonary artery pressure (mPAP) of 29.8 mmHg (ULN 43.0). Additionally, the study reports an mPAP/cardiac output (CO) slope of 1.4 mmHg·min·L (ULN 3.0), an E/e' ratio of 7.1 (ULN 11.5), a TAPSE of 31.8 mm (LLN 24.6), and a TAPSE/sPAP of 0.8 mm·mmHg (LLN 0.4).

The authors note significant heterogeneity for several measurements, which may impact the precision of these reference values. Despite this, the meta-analysis provides a framework for defining normal limits in clinical settings. The results are primarily useful for establishing baseline expectations during exercise stress testing.

When a person exercises, their heart works harder to pump blood. Doctors use ultrasound tests, called echocardiograms, to see how well the heart and lungs are performing under this stress. However, because people move during these tests, it can be hard to know what a "normal" result looks like for someone who is active.

Researchers looked at data from over 1,100 healthy people to create a clear set of reference points. They measured several key factors, including blood pressure in the lungs and how well the heart muscle moves. These results provide a solid baseline for doctors to compare against when they check a patient's heart health during an exercise test.

While the data is helpful for creating these standards, there was some variation in how different measurements were recorded across the studies. This means that while the new framework provides a strong guide for what is considered normal, it is one piece of a larger clinical picture.

What this means for you:
New standard measurements help doctors accurately judge heart performance during exercise tests.

Common questions

What does this mean for my heart test?

These findings provide a clear set of reference points for doctors. When you perform an exercise echocardiogram, they can use these specific numbers to see if your heart and lungs are responding normally to physical activity.

What specific measurements were used?

The study looked at several key markers, including systolic pulmonary artery pressure (sPAP), mean pulmonary artery pressure (mPAP), and tricuspid regurgitation velocity. These help doctors see how well your heart handles the stress of exercise.

Is this data reliable for everyone?

The study used a large group of 1,122 healthy subjects to find these averages. However, there was some variation in several measurements, so your doctor will use these as a general framework for what is considered normal.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
Normal limits for exercise Doppler echocardiography (ex-TTE) measurements of the right ventricle (RV), pulmonary artery (PA) and left atrial (LA) unit remain inadequately defined. This meta-analysis aims to establish normal limits for measurements of the RV-PA-LA unit. A comprehensive literature search of Medline, Web of Science and Scopus (1 January 1999-December 2024) was performed. We included ex-TTE studies performed using a supine/semi-recumbent cycle ergometer in healthy subjects that reported the following parameters: tricuspid regurgitation velocity (TRV), systolic pulmonary artery pressure (sPAP), mean pulmonary artery pressure (mPAP), mPAP/cardiac output (CO) slope, mitral Doppler E to tissue Doppler e' ratio (E/e'), tricuspid annular plane excursion (TAPSE) and TAPSE/sPAP. Summary mean estimates were calculated using a restricted maximum-likelihood random-effects model. Lower and upper limits of normal (LLN and ULN) were defined as the 5th and 95th percentiles. Between-study heterogeneity was assessed using the Q-statistic and quantified with the inconsistency index. Data on 1122 healthy subjects (mean±sd age: 42.8±18.3 years) across 19 eligible studies were analysed. The pooled mean estimates and limits of normal for ex-TTE measurements were as follows: TRV 2.5 m·s (ULN 3.4), sPAP 38.5 mmHg (ULN 57.8), mPAP 29.8 mmHg (ULN 43.0), mPAP/CO slope 1.4 mmHg·min·L (ULN 3.0), E/e' 7.1 (ULN 11.5), TAPSE 31.8 mm (LLN 24.6), TAPSE/sPAP 0.8 mm·mmHg (LLN 0.4). Despite notable heterogeneity for several measurements, the present meta-analysis provides a robust framework for defining normal reference limits for ex-TTE measurements of the RV-PA-LA unit.
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