Circulation, Vol 79, 863-871, Copyright © 1989 by American Heart Association
RB Himelman, M Stulbarg, B Kircher, E Lee, L Kee, NC Dean, J Golden, CL Wolfe and NB Schiller
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.
ARTICLES
Noninvasive evaluation of pulmonary artery pressure during exercise by saline-enhanced Doppler echocardiography in chronic pulmonary disease
Department of Medicine, University of California, San Francisco.
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