Uniqueness of the present study and clinical implications
To the best of our knowledge, this is the large EDE multicenter study
that comprehensively provides a detailed quality control analysis of
both the right heart and the pulmonary circulation measurements. One
major finding was that the accuracy and agreement were remarkably high
among 19 experienced investigators, with no significant differences
between resting and exercise measurements. These results provide a valid
evidence of reliability of TRV, E/e’ ratio and LVOT VTI during exercise.
The inter-observer variability of RVOT Act was higher than that of TRV.
RVOT Act measurements were collected during exercise, in keeping with a
recent report advocating its combination with TRV for the assessment of
the pulmonary pressures both at rest and during
exercise.21 The interest of this combination is that
the feasibility rate of RVOT Act may be higher than that of
TRV.22 Furthermore our findings suggested that
exercise TAPSE and S’ may be used as reproducible measures of the RV
longitudinal systolic function. Larger resting and exercise variability
of RV FAC may be caused by plane-dependency and reliance on difficult
definition RV endocardial border.23