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Dynamic and Pharmacologic Right Heart Stress Echocardiography: Right Ventricular Function, Right Coronary Artery Flow, Pulmonary Pressure, and Alveolar–Capillary Membrane Testing in the Echocardiography Laboratory

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Stress Echocardiography

The behavior of the right side of the heart during stress has been underemphasized and sparsely investigated by cardiologists and pneumologists. Reasons vary, but the right ventricle has traditionally been considered a passive conduit between the venous system and the lungs largely because of early animal experiments showing no increase of central venous pressure after the free wall of the right ventricle had been destroyed. In addition, ultrasound systems are generally optimized for imaging of the left ventricle. Recent pathophysiological, clinical, and prognostic data have defined an important role of the right ventricle in many conditions, including ischemic heart disease and heart failure. Given that the right ventricle and the left ventricle share a common septum, have an overlap** blood supply, and are bound together by the pericardium, changes induced by myocardial ischemia and/or heart failure are reflected in pulmonary hemodynamics and right ventricular function. Modern Doppler echocardiography allows a systematic evaluation of five key aspects of cardiopulmonary pathophysiology during stress: segmental right ventricular function; global right ventricular longitudinal function; coronary flow reserve in the posterior descending of the right coronary artery; indices of pulmonary hemodynamics, namely, pulmonary artery systolic pressure, pulmonary velocity time integrals, and pulmonary vascular resistances; and extravascular lung water in the lung, mirroring the distress of the alveolar–capillary membrane.

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Authors and Affiliations

  1. Pulmonary Hypertension Unit Department of Cardiology and Pneumology, University Hospital Heidelberg INF 410, Heidelberg, 69120, Germany

    Ekkehard Grünig

  2. Department of Cardiology Instituto de Ciencias del Corazón (ICOCOR), Hospital Clnico Ramón y Cajal, 3, Valladolid, 47005, Spain

    Alberto San Román

  3. Echo Laboratory, Asan Medical Center Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu Seoul, Republic of Korea

    Kwan Damon

  4. Division of Cardiology Department of Medicine, San Francisco Veterans Affairs Hospital University of California San Francisco, Box 0214, San Francisco, CA, 94143-0214, USA

    Nelson B. Schiller

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  1. Eugenio Picano
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Editors and Affiliations

  1. Director General Institute of Clinical Physiology of Pisa, National Research Council, 1st Fisiologia Clinica, Via G. Moruzzi, 1, Pisa, 56124, Italy

    Eugenio Picano MD, PhD

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Picano, E., Grünig, E., Román, A.S., Damon, K., Schiller, N.B. (2009). Dynamic and Pharmacologic Right Heart Stress Echocardiography: Right Ventricular Function, Right Coronary Artery Flow, Pulmonary Pressure, and Alveolar–Capillary Membrane Testing in the Echocardiography Laboratory. In: Picano, E. (eds) Stress Echocardiography. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-76466-3_8

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  • DOI: https://doi.org/10.1007/978-3-540-76466-3_8

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