title: Noninvasive assessment of right heart function and hemodynamics during exercise in patients with pulmonary arterial hypertension.
abstract: OBJECTIVE
  Noninvasive assessment of right heart function and hemodynamics in patients with pulmonary arterial hypertension (PAH) is most often performed at rest, whereas the symptoms, in general, present with exertion. Assessment during exertion is limited to symptom assessment and the 6-minute walk distance. We investigated the feasibility of obtaining echocardiographic data that could accurately reflect pulmonary artery pressures (PAP), particularly mean PAP and right ventricular function during exercise in patients with PAH.
  
  
  METHODS
  We investigated right ventricular function and hemodynamics using echocardiography during symptom-limited exercise in 10 consecutive patients undergoing right heart catheterization (RHC) as part of their clinical evaluation for PAH. We further assessed these measurements for correlation with known predictors of outcome in PAH in an exploratory analysis.
  
  
  RESULTS
  We were able to successfully obtain complete right heart measurements by echocardiography, including mean PAP, in the majority (9 of 10) of the subjects. One patient had an incomplete tricuspid regurgitation jet at rest and with exercise. Echocardiographic pulmonary vascular resistance correlated with RHC cardiac output and brain natriuretic peptide level, whereas tricuspid annular plane systolic excursion during exercise correlated with right atrial pressure on RHC, brain natriuretic peptide, and 6-minute walk distance. Tricuspid regurgitation velocity and mean PAP with exercise correlated moderately with mean PAP and cardiac output by RHC.
  
  
  CONCLUSIONS
  Exercise echocardiography can provide meaningful data in patients with PAH, including measuring mean PAP. The presence of correlations in this small number of patients indicates promising targets for future investigation.
authors: Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida, USA. freeman.michelle@mayo.edu
authors: Michelle L
authors: ML
authors: Freeman
authors: Carolyn
authors: C
authors: Landolfo
authors: Robert E
authors: RE
authors: Safford
authors: Cesar A
authors: CA
authors: Keller
authors: Michael G
authors: MG
authors: Heckman
authors: Charles D
authors: CD
authors: Burger
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D025401:Echocardiography, Stress; D017079:Exercise Tolerance / Q000502:physiology; D005240:Feasibility Studies; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011651:Pulmonary Artery / Q000502:physiology; D014262:Tricuspid Valve Insufficiency / Q000503:physiopathology; D014655:Vascular Resistance / Q000502:physiology; D016278:Ventricular Function, Right / Q000502:physiology*
chemical_list: D020097:Natriuretic Peptide, Brain
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