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