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 echography (based on the pressure gradient between the right ventricule and right atrium - ΔP 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 ΔP 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 ous 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 ΔP RV/RA was determined from the tricuspid regurgitation jet using continuous wave Doppler in left lateral decubitus (LLD) before exercise terting (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 ΔP RV/RA in BLLD was 36±21 mmHg (range 18 to 147); the SP OP RV/RA was 32±24 mmHg (range 12 to 137), p<0.001 vs. BLLD ΔP RV/RA; the PW ΔP RV/RA was therapeutic decisions in 10 pateients (18%) with treadmill exercise testing was feasible in most differences between PW ΔP RV/RA and RLLD ΔP RV/RA influenced patient management.