Figure 3).

Example of the exercise-induced Doppler parameter changes in a patient with a marked increase in pulmonary capillary wedge pressure from 12 mmHg at rest to 37 mmHg at peak exercise. Left column, data at rest ( A, B, C) ; right column, data immediately after peak exercise (D, E, F) . Panels A and D represent transmitral Doppler filling flow (peak early diastolic transmitral velocity [E] = 61 cm/s, E at peak exercise = 142 cm/s); the remaining images represent septal ( B, E) and lateral (C, F) tissue Doppler velocities of the mitral annular motion. Average peak early diastolic mitral annular velocity (e′) rose from 12.1 cm/s to 15.1 cm/s and average peak systolic mitral annular velocity (s′) changed minimally from 7.3 cm/s to 7.2 cm/s. E/e′ exhibited exercise-induced elevation from 5.0 to 9.4, while E/s′ rose more convincingly from 8.4 to 19.7, both indicating exercise PCWP ≥25 mmHg