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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Exercise echocardiography in pulmonary hypertension

Jean-Luc Vachiéry* and Adriana Pavelescu

Département de Cardiologie, Hôpital Erasme, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium

* Corresponding author. Tel: +32 2 5554866; fax: +32 2 5556567. E-mail address: ejean-luc.vachiery{at}ulb.ac.be

Doppler echocardiography plays a key role in the detection of pulmonary hypertension, the leading cause of right ventricular (RV) dysfunction. Reliable estimates of pulmonary pressures and cardiac output (CO) can be obtained at rest, allowing for screening and diagnosis of pulmonary arterial hypertension (PAH), a group of diseases characterized by increased pulmonary vascular resistance progressing to RV failure and death. However, these resting indices poorly correlate with symptoms, exercise response, and have modest prognosis significance. This is partially explained by the limited information obtained from pressure measurements on the severity of RV dysfunction, the major determinant of exercise response and prognosis in PAH. Exercise echocardiography (Ex-echo) may provide significant additional information in the understanding and the management of the disease. In asymptomatic subjects at risk of PAH, it may uncover abnormal increases in pulmonary pressure and CO during exercise, which may be reflecting early stage disease. In addition, the technique may be useful to better understand the physiology of exercise limitation, a typical manifestation of PAH. Several limitations need to be considered when using Ex-echo in the management of PAH, including the absence of a clear consistent definition of normal values, an unknown threshold for abnormal response and the limited quantitative information on RV function provided by simple pressure analysis. Newer echocardiographic techniques such as Tissue-Doppler imaging, and strain and strain rate analysis may provide further insights in the understanding of RV dysfunction. However, technical limitations currently prevent their application to Ex-echo. Clinical studies are underway to better explore the potential role of Ex-echo in the management of PAH.

Key Words: Doppler echocardiography • Exercise testing • Exercise echocardiography • Right ventricular function • Pulmonary hypertension


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