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From the Echo Bed to the Pulmonary Vascular BedDobutamine Echo in Pulmonary Hypertension: Dobutamine Testing in the Noninvasive Laboratory

Lawrence G. Rudski, MD; Eduardo Bossone, MD, PhD, FCCP; David Langleben, MD
Author and Funding Information

From the Division of Cardiology, Jewish General Hospital, McGill University; and Department of Cardiology and Cardiac Surgery, University Hospital Scuola Medica Salernitana.

CORRESPONDENCE TO: Lawrence G. Rudski, MD, Center for Pulmonary Vascular Diseases, Division of Cardiology, Jewish General Hospital, McGill University, 3755 Cote Sainte Catherine Rd, Ste E-206, Montreal, QC, H3T 1E2, Canada; e-mail: lrudski@jgh.mcgill.ca


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following conflicts of interest: Dr Rudski has minor stock holdings in General Electric outside of a managed portfolio. Drs Bossone and Langleben have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):876-878. doi:10.1378/chest.14-0856
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Cardiovascular physiology, in its simplest form, can be summed up by two very basic equations: right = left and V = IR (where V indicates voltage, and IR indicates the product of current and resistance). The former equation states that, in the absence of shunt, the left heart can only pump what it receives from the right. The latter equation, Ohm’s law, is transposed in cardiology as pressure = flow × resistance. In vivo, of course, this relationship is far more complex as the pulmonary circulation is not a set of rigid pipes, and the flow is pulsatile. The mechanism of right ventricle (RV) contraction remains enigmatic, and fully characterizing the RV-pulmonary artery coupling relationship is difficult.1 The challenge to clinicians and scientists is to move beyond these very basic equations, while respecting their principles.

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