Exercise Doppler echocardiography for the diagnosis of pulmonary hypertension: renewed interest and evolving roles

Exercise-induced pulmonary hypertension (PHT) was defined historically as an increase of >30 mmHg in the mean pulmonary artery pressure (MPAP) during exercise in patients who otherwise had a normal MPAP at rest (1). This concept was adopted for almost two decades before it was dropped from the diagnostic criteria of PHT in 2008 following the 4th World Symposium on PHT due to the ambiguity in the cut-off values for abnormality (2). In recent years, however, the tide might have turned. New and improved definitions for exercise PHT have been proposed and validated in a variety of patient cohorts, generating interest and bringing exercise PHT back into the limelight (3,4). As the latest iteration of the World Symposium on PHT in Nice approaches, this paper by van Riel et al. is both timely and relevant