Rozenbaum Z, Ben-Gal Y, Kapusta L, et al. - This study was intended to apply combined echo and cardiopulmonary exercise to evaluate limitations in chronic obstructive pulmonary disease (COPD) patients. Researchers evaluated 20 patients with COPD and 20 matched control applying combined cardiopulmonary and stress echocardiographic testing. It was shown that in patients with COPD, combined cardiopulmonary and stress echocardiographic testing can be beneficial in determining individual mechanisms of exercise intolerance. The results revealed that exercise intolerance is predominantly the result of chronotropic incompetence, limited stroke volume reserve, exercise-induced elevation in left filling pressure, and peripheral factors and not simply obstructive lung function in patients with COPD. The outcomes suggested that limited stroke volume is related to abnormal right ventricular contractile reserve and reduced left ventricular compliance introduced through septal flattening and direct ventricular interaction.