Echocardiographic evaluation of the pulmonary circulation and right ventricular functional unit during exercise and its clinical value

Purpose of review In this review, we provide an overview of the echocardiographic evaluation of the pulmonary circulation – right ventricular functional unit during exercise and its clinical value. Recent findings An increased understanding on the physiological response of pulmonary hemodynamics during exercise and evidence of the impact of an abnormal mean pulmonary arterial pressure (mPAP)/cardiac output (CO) slope on survival led to the reintroduction of exercise pulmonary hypertension (EPH), defined as a mPAP/CO slope >3 mmHg/l/min, in the current European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines for pulmonary hypertension. Additionally, noninvasive exercise echocardiography may enable easy and readily available assessment of pulmonary exercise hemodynamics. Summary Impaired pulmonary exercise hemodynamics are considered early hemodynamic signs of cardiopulmonary disease. In order to diagnose EPH, exercise right heart catheterization (RHC) is needed, which is invasive, highly cost- and staff intensive and reserved to expert centers. Noninvasive surrogates derived from exercise echocardiography might be an appropriate alternative to invasive RHC.