The cardiopulmonary vascular system represents a key determinant of prognosis in several cardiorespiratory diseases. Although right heart catheterization is considered the gold standard for assessing pulmonary hemodynamics, a comprehensive noninvasive evaluation including left and right ventricular reserve and function and cardiopulmonary interactions remains highly attractive. Stress echocardiography is crucial in the evaluation of many cardiac conditions, typically coronary artery disease but also heart failure and valvular heart disease. In stress echocardiographic applications beyond coronary artery disease, the assessment of the cardiopulmonary vascular system is a cornerstone. The possibility of coupling the left and right ventricles with the pulmonary circuit during stress can provide significant insight into cardiopulmonary physiology in healthy and diseased subjects, can support the diagnosis of the etiology of pulmonary hypertension and other conditions, and can offer valuable prognostic information. In this state-of-the-art document, the topic of stress echocardiography applied to the cardiopulmonary vascular system is thoroughly addressed, from pathophysiology to different stress modalities and echocardiographic parameters, from clinical applications to limitations and future directions.

心肺血管系统是几种心肺疾病预后的关键决定因素。尽管右心导管检查被认为是评估肺血流动力学的金标准，但包括左，右心室储备和功能以及心肺相互作用的综合无创性评估仍然非常有吸引力。应力超声心动图对于评估许多心脏疾病至关重要，这些疾病通常是冠状动脉疾病，而且还包括心力衰竭和瓣膜性心脏病。在冠状动脉疾病以外的压力超声心动图应用中，心肺血管系统的评估是基石。压力期间左右心室与肺回路耦合的可能性可以为健康和患病受试者的心肺生理学提供重要见解，可以支持肺动脉高压和其他疾病的病因诊断，并可以提供有价值的预后信息。在这份最新的文件中，从病理生理学到不同的压力形态和超声心动图参数，从临床应用到局限性和未来方向，彻底解决了应用于心肺血管系统的压力超声心动图的主题。