Noninvasive evaluation of pulmonary artery pressure during exercise by saline-enhanced Doppler echocardiography in chronic pulmonary disease.

Abstract

To determine the feasibility of noninvasive determination of right ventricular systolic pressure (RVSP) during a graded-exercise protocol, saline contrast-enhanced Doppler echocardiography of tricuspid insufficiency was performed in 36 patients with chronic lung disease and 12 normal controls. In the patients with chronic pulmonary disease, symptom-limited, incremental supine bicycle exercise and pulse oximetry were performed on and off high-flow oxygen. Technically adequate Doppler studies were initially obtained in 20 patients (56%) at rest and 14 (39%) on exercise; these numbers increased to 33 (92%) and 32 (89%), respectively, after enhancement with agitated saline (both p less than 0.001). In 10 patients with chronic lung disease who had simultaneous hemodynamic monitoring during exercise, the correlation between Doppler and catheter measurements of pulmonary artery systolic pressure was close (r = 0.98). Among controls, RVSP increased from 22 +/- 4 at rest (mean +/- SD) to 31 +/- 7 mm Hg at peak exercise. In patients with chronic lung disease, RVSP increased from 46 +/- 20 to 83 +/- 30 mm Hg (both p less than 0.001 vs. controls). Despite normal resting values for RVSP in 28% of study patients, nearly all showed abnormal increases in RVSP during supine bicycle exercise. Increases in RVSP during exercise were greatest in patients who showed oxyhemoglobin desaturation. The short-term administration of oxygen significantly blunted the increase in RVSP during exercise. Saline contrast-enhanced Doppler evaluation of tricuspid insufficiency seems a potentially valuable noninvasive method of determining the exercise response of RVSP in patients with chronic pulmonary disease.

Role of echocardiography in detecting portopulmonary hypertension in liver transplant candidates

“…Our findings and those of Torregrosa et al 10 differ from initial studies validating the use of Doppler echocardiography in assessing pulmonary pressures [5][6][7][8][9] that reported better correlations between the two modalities. One explanation for this difference is that in the original validation studies, a significant portion of patients' echocardiograms were deleted from analysis because of inadequate imaging of the regurgitant jet.…”

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…Formal hemodynamic exercise testing can be done noninvasively with either a supine bicycle or upright treadmill with Doppler recordings of transmitral and tricuspid velocities. 406 -409 This allows measurement of both the transmitral gradient [407][408][409] and pulmonary artery systolic pressure 406,408 at rest and with exercise. 410 The criteria for the assessment of the severity of MS are summarized in Table 4.…”

Update on pulmonary hypertension complicating chronic obstructive pulmonary disease

“…42 In a study by Himelman and colleagues, the detection rate of TR jet could be improved from 56% to 92% (P  0.001) by the use of agitated saline contrast. 43 These studies show low sensitivity of ECHO in estimating PAP in COPD patients and agitated saline contrast may improve the detection rate. Fisher and colleagues compared echocardiographic estimate of PAP with RHC.…”