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Stress Echocardiography in Pulmonary Hypertension

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Stress Echocardiography

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Abstract

Pulmonary hypertension can be precapillary or postcapillary. This distinction is only possible by invasive means, although echocardiography is the essential technique for identification, quantification, and monitoring. Pulmonary hypertension is defined by right heart catheterization criteria as a mean pulmonary arterial pressure > 20 mmHg. Precapillary pulmonary hypertension is characterized by a normal pulmonary capillary wedge pressure ≤ 15 mmHg and abnormal pulmonary vascular resistance (> 2 Wood units) reflecting a primary abnormality of pulmonary arterioles upstream to the alveolar-capillary barrier. Postcapillary pulmonary hypertension in heart failure is characterized by an abnormal pulmonary capillary wedge pressure (>15 mmHg) and normal pulmonary vascular resistance (≤ 2 Wood units). The presence of signs of pulmonary hypertension with a normal left heart, normal E/e′ ratio, and normal left atrial volume are suggestive of precapillary pulmonary hypertension. In addition, stress echocardiography can evaluate dynamically systolic pulmonary artery pressure with tricuspid regurgitant velocity jet or acceleration time of pulmonary flow. The right ventricular contractile reserve is also assessed with tricuspid annular plane systolic excursion to evaluate the right ventricular/pulmonary artery systolic pressure coupling. In the natural history of pulmonary hypertension, changes occur during exercise at an earlier stage compared to rest and therefore stress echocardiography shows a clear potential to identify these changes at a less severe and more reversible stage.

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Authors and Affiliations

  1. Department of Public Health, University of Naples Federico II, Naples, Italy

    Eduardo Bossone

  2. Cava de’ Tirreni and Amalfi Coast Division of Cardiology, University Hospital, Salerno, Italy

    Francesco Ferrara

  3. Institute of Clinical Physiology of the National Research Council, Pisa, Italy

    Eugenio Picano

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  1. Eduardo Bossone
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  2. Francesco Ferrara
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  3. Eugenio Picano
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  1. Institute of Clinical Physiology of the National Research Council, Pisa, Italy

    Eugenio Picano

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Bossone, E., Ferrara, F., Picano, E. (2023). Stress Echocardiography in Pulmonary Hypertension. In: Picano, E. (eds) Stress Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-031-31062-1_36

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