RV ‐ LV volumetric relationship during graded supine exercise in healthy adults assessed by cardiovascular magnetic resonance

Q: What are the key findings of this study?

Graded supine exercise maintained stable RV/LV end-diastolic (1.03 vs 1.03, p=0.677) and end-systolic (1.08 vs 1.09, p=0.842) volume ratios in healthy adults.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Healthy adults without cardiopulmonary diseases (n=18). Intervention: Graded supine ergometer exercise during ECG-gated cardiovascular magnetic resonance imaging (exCMR) vs. Rest state in supine position. Primary outcome: RV/LV end-diastolic volume (EDV) ratio across rest and exercise stages (Ex1: target HR 100 bpm; Ex2: 40% of peak work rate) (p=0.677).

Q: What does this research mean for the field?

Healthy adults maintain stable right ventricular to left ventricular end-diastolic and end-systolic volume ratios during low-to-moderate supine exercise, with stroke volume augmentation driven predominantly by decreased end-systolic volume. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Megumi Ikeda; Michinari Hieda; Keimei Yoshida; Misaki Imabayashi; Daisuke Toyomura; Ryo Izumi; Akiko Nishizaki; Tatsuhiro Wada; Yuya Saito; Chiaki Tokunaga; Kei Nishikawa; Saki Kurokawa; Yuya Fukudome; Takuya Hino; Yuzo Yamasaki; Kazuya Hosokawa; Mitsuhiro Fukata; Kousei Ishigami; Kohtaro Abe; K Akashi

doi:10.14814/phy2.71206

Key result

Graded supine exercise maintains stable RV-to-LV volume ratios during stress in healthy adults.

P=0.677
n=18

Figures

Graphical abstract published by Physiological Reports — Graphical abstract · Published by Physiological Reports · CC BY

Why the study?

Quantitative physiological reference data characterizing right ventricular-left ventricular volumetric relationships in healthy adults during graded supine exercise using exercise cardiovascular magnetic resonance imaging were needed.

Does graded low-to-moderate intensity supine exercise alter the relative right-to-left ventricular (RV/LV) end-diastolic and end-systolic volume ratios in healthy adults assessed by exercise cardiovascular magnetic resonance?

Key Points

Characterize right ventricular to left ventricular volumetric relationships across graded supine exercise stages in healthy adults using cardiovascular magnetic resonance.
Studied 18 healthy adults (9 males, 9 females; mean age 36 ± 11 years) who completed cardiopulmonary exercise testing and exercise cardiovascular magnetic resonance imaging (exCMR).
Acquired electrocardiography-gated short-axis cine and phase-contrast flow images at rest, at a target heart rate of 100 beats/min (Ex1), and at 40% of peak work rate (Ex2).
The RV/LV end-diastolic volume ratio remained at 1.03 ± 0.04 across rest, Ex1, and Ex2 (p = 0.677), and the RV/LV end-systolic volume ratio remained stable at 1.09 ± 0.14, 1.09 ± 0.12, and 1.08 ± 0.13, respectively (p = 0.842).
Stroke volume index increased significantly in both ventricles from rest to Ex2 (LV: 47.7 ± 4.6 to 54.1 ± 6.1 mL/m², p < 0.0001; RV: 48.0 ± 3.8 to 54.8 ± 5.4 mL/m², p < 0.0001) primarily through end-systolic volume reduction, while end-diastolic volume remained relatively unchanged.

Study Design

Type

Observational (n=18)

Multicenter

No

Structured PICO

Does graded low-to-moderate intensity supine exercise alter the relative right-to-left ventricular (RV/LV) end-diastolic and end-systolic volume ratios in healthy adults assessed by exercise cardiovascular magnetic resonance?

P

Population

18 healthy young adults (mean age 36 years, 50% female) without cardiopulmonary disease who underwent graded supine exercise cardiovascular magnetic resonance imaging.

E

Exposure

Graded submaximal supine cycle ergometer exercise during free-breathing, ECG-gated 3.0 T cardiovascular magnetic resonance imaging (exCMR) at two stages: target heart rate of 100 beats/min (Ex1, mean 33 ± 27 W) and 40% of peak work rate achieved during upright CPX (Ex2, mean 67 ± 22 W), for at least 2 minutes of stabilization plus ~3 minutes of image acquisition per stage.

C

Comparator

Baseline supine rest state prior to placing feet on ergometer pedals (within-subject repeated-measures comparison).

O

Outcome

Relative right ventricular-to-left ventricular (RV-LV) volumetric relationship, operationally represented by the RV/LV end-diastolic volume (EDV) ratio and RV/LV end-systolic volume (ESV) ratio derived from simultaneous short-axis cine CMR volumetry at rest, Ex1, and Ex2.surrogate

Main Result

Absolute Event Rate: 1.03% vs 1.03%

p-value: p=0.677

Limitations

Modest sample size (n = 18).
Exercise stages were limited to submaximal low-to-moderate intensity (target HR 100 bpm and 40% of peak work rate).
Absence of invasive hemodynamic measurements precluded direct correlation of volume ratios with PVR/SVR ratios.
Myocardial deformation parameters (strain and twist/torsion) were not evaluated due to respiratory motion and elevated heart rates during free-breathing exercise.
Relatively young cohort of healthy adults limits applicability to older individuals.
Modest sample size (n = 18)
Exercise stages limited to submaximal low-to-moderate intensity (target HR 100 bpm and 40% of peak work rate)
Absence of invasive hemodynamic measurements to correlate volume ratios with pulmonary and systemic vascular resistance
Myocardial deformation parameters (strain, twist/torsion) were not evaluated due to free-breathing respiratory motion and elevated heart rates
Relatively young cohort (mean age 36 years), limiting generalizability to older populations

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Implication

Provides reference RV/LV volume ratios during supine exercise in healthy adults; leaves open validation in pulmonary vascular disease and HFpEF.

Abstract

Exercise cardiovascular magnetic resonance imaging (exCMR) enables quantitative assessment of biventricular responses during physiological stress. We aimed to characterize right ventricular (RV)-left ventricular (LV) volumetric relationships in healthy adults using exCMR. Eighteen healthy adults (9 males, 9 females) underwent exCMR. Electrocardiography-gated short-axis cine and phase-contrast flow images were obtained at rest, at a target heart rate of 100 beats/min (Ex1), and at 40% of peak work rate determined by cardiopulmonary exercise testing (Ex2). The RV-LV volumetric relationship was operationally represented by the RV/LV end-diastolic and end-systolic volume ratios derived from simultaneous cine volumetry. All participants completed the protocol, and all cine and phase-contrast datasets were analyzed. During exercise, stroke volume increased in both ventricles predominantly through a reduction in end-systolic volume (ESV), whereas end-diastolic volume (EDV) changed little. Cine-derived LV and RV stroke volumes showed internal concordance with phase-contrast flow-derived measurements. The RV/LV EDV ratio (1.03, 1.03, and 1.03 at rest, Ex1, and Ex2, respectively) and RV/LV ESV ratio (1.09, 1.09, and 1.08 at rest, Ex1, and Ex2, respectively) remained stable across stages. Healthy adults maintained a stable relative RV-LV volumetric relationship during low-to-moderate intensity supine exercise. These findings provide quantitative physiological reference data for future disease-focused studies.

Discussion

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Cite This Study

Ikeda et al. (2026) conducted an observational in Healthy adults without cardiopulmonary diseases (n=18). Graded supine ergometer exercise during ECG-gated cardiovascular magnetic resonance imaging (exCMR) vs. Rest state in supine position was evaluated on RV/LV end-diastolic volume (EDV) ratio across rest and exercise stages (Ex1: target HR 100 bpm; Ex2: 40% of peak work rate) (p=0.677). Graded supine exercise maintained stable RV/LV end-diastolic (1.03 vs 1.03, p=0.677) and end-systolic (1.08 vs 1.09, p=0.842) volume ratios in healthy adults.

synapsesocial.com/papers/6aefbd4950d2071ffda4bc36 https://doi.org/10.14814/phy2.71206

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RV ‐ LV volumetric relationship during graded supine exercise in healthy adults assessed by cardiovascular magnetic resonance

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

RV ‐ LV volumetric relationship during graded supine exercise in healthy adults assessed by cardiovascular magnetic resonance

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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