Pulmonary medicine · 2026
Stress Echocardiography to Detect Exercise Pulmonary Hypertension in Patients With Chronic Thromboembolic Pulmonary Disease.
Сравнительное исследованиеСтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Dhayyat Adam, Stavem Knut, Jervan Øyvind, Hilde Janne Mykland, Rashid Diyar, Gleditsch Jostein, Ghanima Waleed, Steine Kjetil
Аннотация
BACKGROUND: This study was aimed at determining whether stress echocardiography could detect exercise pulmonary hypertension (ePH) in patients with mild chronic thromboembolic pulmonary disease (CTEPD) as compared with right-heart catheterization (RHC).
METHODS: Thirty-six symptomatic patients with persistent residual perfusion defects detected using ventilation/perfusion scintigraphy underwent a haemodynamic assessment by RHC and echocardiography at rest and during exercise. We compared pulmonary pressures in echocardiography with RHC values using the definitions in current ESC/ERS guidelines for ePH [mean pulmonary artery pressure/cardiac output (mPAP/CO) slope > 3 mmHg/L/min] and PH (mPAP > 20 mmHg).
RESULTS: Ten of the 36 patients (28%) exhibited an increase in the invasive mPAP/CO slope of > 3 mmHg/L/min. The correlation between echocardiographic and invasive measures of the mPAP/CO slope and systolic pulmonary pressure (sPAP) during peak exercise was ρ = 0.75 (95% C I = 0.53-0.97) and ρ = 0.75 (95% C I = 0.53-0.96), respectively. In bivariate logistic regression analyses, ePH was associated with the echocardiographic sPAP during peak exercise [o d d s r a t i o (OR) = 1.13, 95% C I = 1.02-1.24] and with the echocardiographic mPAP/CO slope (OR = 3.86, 95% C I = 1.24-12.03). In ROC analysis, AUC was 0.89 (95% C I = 0.78-1.00) for the optimal exercise sPAP cut-off value of 56 mmHg (s e n s i t i v i t y = 90%, s p e c i f i c i t y = 87%), and 0.84 (95% C I = 0.66-1.00) for the optimal mPAP/CO slope cut-off value of 3.7 mmHg/L/min (s e n s i t i v i t y = 89%, s p e c i f i c i t y = 79%).
CONCLUSION: Stress echocardiographic assessments of the exercise sPAP and mPAP/CO slope predicted ePH as measured using RHC with good discrimination and acceptable calibration, providing promising evidence in diagnosing ePH in patients with CTEPD.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03405480.
METHODS: Thirty-six symptomatic patients with persistent residual perfusion defects detected using ventilation/perfusion scintigraphy underwent a haemodynamic assessment by RHC and echocardiography at rest and during exercise. We compared pulmonary pressures in echocardiography with RHC values using the definitions in current ESC/ERS guidelines for ePH [mean pulmonary artery pressure/cardiac output (mPAP/CO) slope > 3 mmHg/L/min] and PH (mPAP > 20 mmHg).
RESULTS: Ten of the 36 patients (28%) exhibited an increase in the invasive mPAP/CO slope of > 3 mmHg/L/min. The correlation between echocardiographic and invasive measures of the mPAP/CO slope and systolic pulmonary pressure (sPAP) during peak exercise was ρ = 0.75 (95% C I = 0.53-0.97) and ρ = 0.75 (95% C I = 0.53-0.96), respectively. In bivariate logistic regression analyses, ePH was associated with the echocardiographic sPAP during peak exercise [o d d s r a t i o (OR) = 1.13, 95% C I = 1.02-1.24] and with the echocardiographic mPAP/CO slope (OR = 3.86, 95% C I = 1.24-12.03). In ROC analysis, AUC was 0.89 (95% C I = 0.78-1.00) for the optimal exercise sPAP cut-off value of 56 mmHg (s e n s i t i v i t y = 90%, s p e c i f i c i t y = 87%), and 0.84 (95% C I = 0.66-1.00) for the optimal mPAP/CO slope cut-off value of 3.7 mmHg/L/min (s e n s i t i v i t y = 89%, s p e c i f i c i t y = 79%).
CONCLUSION: Stress echocardiographic assessments of the exercise sPAP and mPAP/CO slope predicted ePH as measured using RHC with good discrimination and acceptable calibration, providing promising evidence in diagnosing ePH in patients with CTEPD.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03405480.