Exercise Right Heart Catheterization

Figures

• 

  Figure 1. Transthoracic Echocardiographic Images (A, B) A mildly dilated right ventricle (RV) (orange arrow) with mild systolic septal flattening, suggestive of pressure overload. (C) Continuous-wave Doppler signal across the tricuspid valve demonstrating an estimated right ventricular systolic pressure of 53 mm Hg. (D) Assessment of RV function showing a borderline normal tricuspid annular plane systolic excursion of 17 mm. Regional wall motion analysis indicates borderline reduced systolic function at the apex and midsegment of the RV free wall.

• 

  Figure 2. RHC Tracing (A) Right heart catheterization (RHC) tracing at rest. Pulmonary artery pressure (PAP) at rest is 41/16 mm Hg with a mean PAP (mPAP) of 26 mm Hg and heart rate of 61 beats/min. This tracing demonstrates mild elevation in mPAP. (B) RHC tracing during isometric handgrip exercise. PAP increases significantly during exercise to 74/33 mm Hg with an mPAP of 49 mm Hg and heart rate of 82 beats/min. This exaggerated pulmonary pressure response to low-level exertion is diagnostic of exercise-induced pulmonary arterial hypertension. (C) RHC tracing during exercise after administration of 40 parts per million inhaled nitric oxide (iNO). With iNO and continued exertion, PAP markedly improves to 38/20 mm Hg with an mPAP of 29 mm Hg, and the heart rate is 94 beats/min. This blunted pressure response indicates pulmonary vasoreactivity, supporting the use of pulmonary vasodilator therapy.