Pulmonary Vascular Function During Exercise
Progressing Toward Routine Clinical Use
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
- arterial pressure
- exercise echocardiography
- exercise testing
- pulmonary hypertension
It is widely recognized that a disproportionate increase in pulmonary artery pressure (PAP) during exercise is an important clinical finding with diagnostic and prognostic utility in many cardiac and pulmonary vascular conditions.1 It is a real clinical entity that lacks a real definition. Abnormal increases in PAP were removed from recent iterations of pulmonary hypertension definitions,2,3 not because of a lack of clinical significance, but rather because of questionable specificity resulting from widely variable methodologies. In particular, early definitions of exercise-induced pulmonary hypertension failed to consider that PAP increases with exercise intensity in a near-linear manner in healthy individuals.1,2 Furthermore, some investigators focused on systolic PAP (sPAP),4,5 others on mean PAP (mPAP),6 while estimates of right atrial pressure have been variably incorporated.7,8 Thus, the accuracy and precision of echocardiographic PAP estimates during exercise have been much debated.
See Article by van Riel et al
The data of van Riel et al9 in this issue of Circulation: Cardiovascular Imaging interrogate the accuracy of exercise estimates of pulmonary vascular hemodynamics during exercise and provides further confidence for the incorporation of exercise assessments in the assessment of the breathless patient. They performed echocardiographic estimates of PAP with simultaneous gold standard invasive pressure measurements in patients with unexplained exercise intolerance. In addition to the typical echocardiographic assessment of sPAP using the peak transtriscupid regurgitation (TR) velocity and modified Bernouilli equation, the authors estimated mPAP by tracing the TR spectral Doppler envelope. Based on the quality of the Doppler signal, the envelopes were graded as quality A, B, or C using 2 predefined criteria: (1) extension of the signal for at least half of systole and (2) well-defined border. High-quality (grade A) signals, meaning that both criteria were met, were …