Noninvasive Evaluation of Pulmonary Artery Pressure during Exercise: The Importance of Right Atrial Hypertension

Introduction Identification of elevated pulmonary artery (PA) pressures during exercise has important diagnostic, prognostic, and therapeutic implications. Stress echocardiography is frequently used to estimate PA pressures during exercise testing, but data supporting this practice are limited. This study examined the accuracy of Doppler echocardiography for the estimation of PA pressures at rest and during exercise. Methods Simultaneous cardiac catheterisation-echocardiographic studies were performed at rest and during exercise in 97 subjects with dyspnea. Echocardiography-estimated PA systolic pressure (ePASP) was calculated from the right ventricular to right atrial pressure gradient (eRV-RA) and estimated RA pressure (eRAP), and then compared with directly measured PASP and RAP. Results Estimated PASP was obtainable in 57% of subjects at rest, but feasibility decreased to 15–16% during exercise, due mainly to an inability to obtain eRAP during stress. Estimated PASP correlated well with direct PASP at rest (r=0.76, p Conclusions The RV-RA pressure gradient can be estimated with reasonable accuracy during exercise when measurable. However, RA hypertension frequently develops in patients with EIPH, and the inability to noninvasively account for this leads to substantial underestimation of exercise PA pressures.