Assessment of pulmonary vascular response to exercise with Doppler-echocardiography: state of the art?

There is growing evidence that the evaluation of lung circulation and right ventricular function at rest and during exercise can be helpful to detect exercise induced pulmonary hypertension (1-4), unmask an early pathological involvement of the pulmonary circulation (5,6) and to stratify the prognosis (1,7). Routinely, its evaluation is performed by assessment of the tricuspid regurgitation velocity (TRV), which allows an estimation of systolic pulmonary arterial pressure (sPAP) (8). The recent work by van Riel and collaborators addresses the question, whether estimation of pulmonary pressures during exercise using stress-Doppler echocardiography is accurate and allows diagnostic statements (9). The strength of this study is, that the investigators performed echocardiography and right heart catheterization simultaneously. The study showed high correlations of invasive and noninvasive assessments, both at rest and during exercise, as long as TRV signals revealed a good quality (9).