Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography · 2025
Exercise Echocardiography for Risk Stratification in Unexplained Dyspnea: The Incremental Value of the Mean Pulmonary Artery Pressure/Slope.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Falter Maarten, Bekhuis Youri, L'Hoyes Wouter, Milani Mauricio, Hoedemakers Sarah, Soens Lucie, Moura-Ferreira Sara, Dhont Sebastiaan, Pauwels Rik, Jacobs Annemie, De Schutter Stephanie, Delpire Boris, Verbeeck Johan, Stassen Jan, Gevaert Andreas B, Debonnaire Philippe, Van de Bruaene Alexander, Bertrand Philippe B, Herbots Lieven, Jasaityte Ruta, Verbrugge Frederik H, Claessen Guido, Verwerft Jan
Аннотация
BACKGROUND: Patients with unexplained dyspnea and an elevated mean pulmonary artery pressure (mPAP)/cardiac output (CO) slope on invasive hemodynamic assessment during exercise have worse clinical outcomes. The aim of this study was to evaluate the incremental prognostic value of the noninvasive mPAP/CO slope in addition to heart failure with preserved ejection fraction (HFpEF) probability scores and diastolic stress testing in patients with unexplained dyspnea.
METHODS: In a multicenter cohort study involving six Belgian dyspnea clinics, patients with unexplained dyspnea underwent exercise echocardiography for mPAP/CO slope assessment. Positive HFpEF scores were defined as HFA-PEFF (Heart Failure Association pretest probability echocardiography, functional testing, final diagnosis) score ≥ 5 and H2FPEF (heavy, hypertensive, atrial fibrillation, pulmonary hypertension, elder, filling pressure) score ≥ 6. The outcome evaluated was a composite of all-cause mortality or heart failure hospitalization.
RESULTS: Among 2,452 patients (mean age, 63 ± 15 years; 53% women), mPAP/CO slope > 3.5 mm Hg · L-1 · min-1 best predicted adverse outcomes. The prognostic value of the mPAP/CO slope was greater in patients with negative HFpEF scores than in those with positive scores (interaction P = .02). The mPAP/CO slope remained independently prognostic after adjustment for N-terminal pro-B-type natriuretic peptide (hazard ratio [HR], 2.26; 95% CI, 1.33-3.82) and for HFpEF scores and diastolic stress testing (HR, 1.99; 95% CI, 1.37-2.88), whereas exercise tricuspid regurgitant velocity did not. Both HFpEF score-negative patients with slope > 3.5 mm Hg · L-1 · min-1 (HR, 2.99; 95% CI, 1.81-4.95) and HFpEF score-positive patients (HR, 6.29; 95% CI, 4.25-9.31) showed significantly higher risk compared with HFpEF score-negative patients with slope ≤ 3.5 mm Hg · L-1 · min-1.
CONCLUSIONS: The mPAP/CO slope, unlike exercise tricuspid regurgitant velocity, adds prognostic value beyond natriuretic peptides, HFpEF scores, and diastolic stress testing, identifying high-risk patients with exercise-induced hemodynamic abnormalities who may benefit from invasive confirmation and closer follow-up.
METHODS: In a multicenter cohort study involving six Belgian dyspnea clinics, patients with unexplained dyspnea underwent exercise echocardiography for mPAP/CO slope assessment. Positive HFpEF scores were defined as HFA-PEFF (Heart Failure Association pretest probability echocardiography, functional testing, final diagnosis) score ≥ 5 and H2FPEF (heavy, hypertensive, atrial fibrillation, pulmonary hypertension, elder, filling pressure) score ≥ 6. The outcome evaluated was a composite of all-cause mortality or heart failure hospitalization.
RESULTS: Among 2,452 patients (mean age, 63 ± 15 years; 53% women), mPAP/CO slope > 3.5 mm Hg · L-1 · min-1 best predicted adverse outcomes. The prognostic value of the mPAP/CO slope was greater in patients with negative HFpEF scores than in those with positive scores (interaction P = .02). The mPAP/CO slope remained independently prognostic after adjustment for N-terminal pro-B-type natriuretic peptide (hazard ratio [HR], 2.26; 95% CI, 1.33-3.82) and for HFpEF scores and diastolic stress testing (HR, 1.99; 95% CI, 1.37-2.88), whereas exercise tricuspid regurgitant velocity did not. Both HFpEF score-negative patients with slope > 3.5 mm Hg · L-1 · min-1 (HR, 2.99; 95% CI, 1.81-4.95) and HFpEF score-positive patients (HR, 6.29; 95% CI, 4.25-9.31) showed significantly higher risk compared with HFpEF score-negative patients with slope ≤ 3.5 mm Hg · L-1 · min-1.
CONCLUSIONS: The mPAP/CO slope, unlike exercise tricuspid regurgitant velocity, adds prognostic value beyond natriuretic peptides, HFpEF scores, and diastolic stress testing, identifying high-risk patients with exercise-induced hemodynamic abnormalities who may benefit from invasive confirmation and closer follow-up.