Key result
Noninvasive exercise echo may serve as an appropriate alternative to RHC for diagnosing exercise PH.
Why the study?
Diagnosing exercise pulmonary hypertension requires invasive, costly, and staff-intensive exercise right heart catheterization, prompting interest in noninvasive echocardiographic evaluation of the pulmonary circulation and right ventricular functional unit during exercise.
Can noninvasive exercise echocardiography serve as an alternative to invasive right heart catheterization for diagnosing exercise pulmonary hypertension?
Can noninvasive exercise echocardiography serve as an alternative to invasive right heart catheterization for diagnosing exercise pulmonary hypertension?
Exercise echocardiography may provide a noninvasive alternative to right heart catheterization for evaluating pulmonary hemodynamics and diagnosing exercise pulmonary hypertension.
May support noninvasive PH evaluation in select cases; leaves open prospective validation before replacing catheterization.
PURPOSE OF REVIEW: In this review, we provide an overview of the echocardiographic evaluation of the pulmonary circulation - right ventricular functional unit during exercise and its clinical value. RECENT FINDINGS: An increased understanding on the physiological response of pulmonary hemodynamics during exercise and evidence of the impact of an abnormal mean pulmonary arterial pressure (mPAP)/cardiac output (CO) slope on survival led to the reintroduction of exercise pulmonary hypertension (EPH), defined as a mPAP/CO slope >3 mmHg/l/min, in the current European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines for pulmonary hypertension. Additionally, noninvasive exercise echocardiography may enable easy and readily available assessment of pulmonary exercise hemodynamics. SUMMARY: Impaired pulmonary exercise hemodynamics are considered early hemodynamic signs of cardiopulmonary disease. In order to diagnose EPH, exercise right heart catheterization (RHC) is needed, which is invasive, highly cost- and staff intensive and reserved to expert centers. Noninvasive surrogates derived from exercise echocardiography might be an appropriate alternative to invasive RHC.
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John et al. (2025) conducted a review in Exercise pulmonary hypertension. Exercise echocardiography vs. Exercise right heart catheterization was evaluated. Noninvasive exercise echocardiography may serve as an appropriate alternative to invasive right heart catheterization for diagnosing exercise pulmonary hypertension (mPAP/CO slope >3 mmHg/l/min).
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