Kovacs et al.: Assessment of Pulmonary Arterial Pressure during Exercise in Collagen Vascular Disease: Echocardiography versus Right Heart Catheterisation

Kovacs, G; Maier, R; Aberer, E; Brodmann, M; Scheidl, S; Hesse, C; Troester, N; Salmhofer, W; Stauber, R; Fürst, F; Thonhofer, R; Ofner-Kopeinig, P; Gruenig, E; Olschewski, H.
Assessment of Pulmonary Arterial Pressure during Exercise in Collagen Vascular Disease: Echocardiography versus Right Heart Catheterisation.
Chest. 2010; [Fulltext] [PubMed]

Abstract:
Abstract BACKGROUND: This study aimed to compare the results of exercise Doppler echocardiography (EDE) with right heart catheterisation (RHC) and to evaluate the combination of EDE and cardiopulmonary exercise testing (CPET) as a screening method for early pulmonary vasculopathy in patients with connective tissue disease. METHODS: Patients (n=52) with connective tissue disease (predominantly systemic sclerosis) without known PAH (pulmonary arterial hypertension) underwent both EDE and CPET. If systolic pulmonary arterial pressure (SPAP) was >40mmHg during exercise, or peak O(2) uptake was <75% predicted, RHC was suggested. RESULTS: EDE showed an SPAP>40mmHg during exercise in 26/52 patients. Additionally, CPET showed a peak VO(2)<75% predicted in 10/26 patients with SPAP40mmHg in n=25 patients (n=1 at rest, n=24 during exercise). SPAP values assessed by EDE showed no significant difference vs. RHC at rest, 25W, 50W and maximal exercise (difference [95% CI]: 0.3 [-2.7; 3.2], -1.3 [-7.1; 4.4], 0.9 [-7.7; 5.9], and -5.6 [-13.5; 2.2] mmHg). Eight patients with exercise SPAP>40mmHg had an exercise pulmonary arterial wedge pressure >20mmHg, suggesting exercise-induced left ventricular diastolic dysfunction not detectable by EDE. CONCLUSIONS: EDE appears to be a reasonable non-invasive method to detect SPAP increase during exercise in connective tissue disease. In combination with CPET it may be a useful screening tool for early pulmonary vasculopathy, though RHC remains the gold standard for hemodynamic assessment.


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