Background
Exercise Doppler echocardiography (EDE) is standard practice for the evaluation of patients with coronay artery disease. The procedure is now increasingly used for the assessment of right heart and the pulmonary circulation.1-5 However, this technique may be limited, by its understudied inter-observer variability, which may impact on the quality and consistency of diagnostic results. The RIGHT Heart International NETwork (RIGHT-NET) study protocol incorporates a limited number of basic and generally accessible EDE measurements.6,7 Echocardiography of the pulmonary circulation basically relies on estimates of the components of the pulmonary vascular resistance equation, that is pulmonary artery pressure (PAP) from the maximum tricuspid regurgitation velocity (TRV), or the right ventricular outflow tract (RVOT) acceleration time (Act) of PA flow, wedged PAP from the ratio of transmitral flow E and mitral annulus e’ waves and cardiac output (CO) from the left ventricular outflow tract (LVOT) aortic flow. Echocardiography of the right heart relies on estimates of right ventricular surface areas, tricuspid annular plane systolic excursion (TAPSE) and of tissue Doppler–derived tricuspid lateral annular systolic velocity (S’).2,3The present report aims to validate the quality control process of the right heart and pulmonary circulation resting and exercise echo-Doppler variables and harmonize reading criteria among 19 echocardiography laboratories with proven experience participating in the RIGHT-NET study.6,7