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