Echocardiography during treadmill exercise testing for evaluation of pulmonary artery systolic pressure: advantages of the method.

INTRODUCTION: Determination of pulmonary artery systolic pressure by Doppler echocardiography (based on the pressure gradient between the right ventricle and right atrium - DeltaP RV/RA) or by right heart catheterization is useful in evaluating the severity and prognosis of cardiac disease. The aim of the study was to evaluate DeltaP RV/RA non-invasively during treadmill exercise in patients with tricuspid regurgitation and without coronary artery disease.

METHODS: Of a total of 149 patients referred to our echo laboratory, we completed the study in 142 (95%), of whom 120 were women, mean age 52+/-13 years (23 to 82). We studied 68 patients with valvular heart disease (of whom 56 had mitral valve stenosis and sinus rhythm on ECG), 42 with systemic sclerosis, 10 with severe pulmonary hypertension, 12 with a history of pulmonary embolism and 10 healthy controls. The DeltaP RV/RA was determined from the tricuspid regurgitation jet using continuous wave Doppler in left lateral decubitus (LLD) before exercise testing (BLLD), in a standing position (SP), at peak workload (PW) before termination of the test, and in the first 60 seconds of the recovery period in LLD (RLLD).

RESULTS: The DeltaP RV/RA in BLLD was 36+/-21 mmHg (range 18 to 147); the SP [symbol: see text]P RV/RA was 32+/-24 mmHg (range 12 to 137), p<0.001 vs. BLLD DeltaP RV/RA; the PW DeltaP RV/RA was 58+/-26 mmHg (range 28 to 177), p<0.0001 vs. SP DeltaP RV/RA; and the RLLD DeltaP RV/RA was 47+/-25 mmHg (range 20 to 152), p<0.001 vs. PW DeltaP RV/RA. The differences between PW DeltaP RV/RA and RLLD DeltaP RV/RA changed therapeutic decisions in 10 patients (18%) with mitral stenosis, and modified the management of 13 patients (30%) with systemic sclerosis (who then underwent right heart catheterization).

CONCLUSIONS: Echocardiography during treadmill exercise testing was feasible in most patients. The DeltaP RV/RA decreases in response to the standing position. The DeltaP RV/RA rises considerably with exercise in the majority of patients and is significantly higher at peak workload than in the recovery period. The differences between PW DeltaP RV/RA and RLLD DeltaP RV/RA influenced patient management.