Abstract
Introduction Identification of elevated pulmonary artery pressures during exercise has important diagnostic, prognostic and therapeutic implications. Stress echocardiography is frequently used to estimate pulmonary artery pressures during exercise testing, but data supporting this practice are limited. This study examined the accuracy of Doppler echocardiography for the estimation of pulmonary artery pressures at rest and during exercise.
Methods Simultaneous cardiac catheterisation-echocardiographic studies were performed at rest and during exercise in 97 subjects with dyspnoea. Echocardiography-estimated pulmonary artery systolic pressure (ePASP) was calculated from the right ventricular (RV) to right atrial (RA) pressure gradient and estimated RA pressure (eRAP), and then compared with directly measured PASP and RAP.
Results Estimated PASP was obtainable in 57% of subjects at rest, but feasibility decreased to 15–16% during exercise, due mainly to an inability to obtain eRAP during stress. Estimated PASP correlated well with direct PASP at rest (r=0.76, p<0.0001; bias −1 mmHg) and during exercise (r=0.76, p=0.001; bias +3 mmHg). When assuming eRAP of 10 mmHg, ePASP correlated with direct PASP (r=0.70, p<0.0001), but substantially underestimated true values (bias +9 mmHg), with the greatest underestimation among patients with severe exercise-induced pulmonary hypertension (EIPH). Estimation of eRAP during exercise from resting eRAP improved discrimination of patients with or without EIPH (area under the curve 0.81), with minimal bias (5 mmHg), but wide limits of agreement (−14–25 mmHg).
Conclusions The RV–RA pressure gradient can be estimated with reasonable accuracy during exercise when measurable. However, RA hypertension frequently develops in patients with EIPH, and the inability to noninvasively account for this leads to substantial underestimation of exercise pulmonary artery pressures.
Abstract
This study shows that the right atrial component of the estimated pulmonary artery pressure equation is often overlooked, but quite important, and failure to account for this leads to substantial underestimation of the severity of exercise-induced PH http://bit.ly/32xgKTD
Footnotes
This article has an editorial commentary: https://doi.org/10.1183/13993003.02385-2019
This article has supplementary material available from erj.ersjournals.com
This study is registered at clinicaltrials.gov with identifier NCT01418248.
Conflict of interest: M. Obokata has nothing to disclose.
Conflict of interest: G.C. Kane has nothing to disclose.
Conflict of interest: H. Sorimachi has nothing to disclose.
Conflict of interest: Y.N.V. Reddy reports grants from NIH (T32 HL007111), outside the submitted work.
Conflict of interest: T.P. Olson has nothing to disclose.
Conflict of interest: A.C. Egbe has nothing to disclose.
Conflict of interest: V. Melenovsky reports grants from the Czech Healthcare Research Grant Agency (17-28784A), outside the submitted work.
Conflict of interest: B.A. Borlaug reports grants from NIH (R01 HL128526, R01 HL 126638, U01 HL125205, U10 HL110262), outside the submitted work.
Support statement: This study was supported by an award from the Mayo Department of Cardiovascular Diseases. B.A. Borlaug is supported by R01 HL128526, R01 HL 126638, U01 HL125205 and U10 HL110262.
- Received August 14, 2019.
- Accepted November 2, 2019.
- Copyright ©ERS 2020
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