Stress Echocardiography to Detect Exercise Pulmonary Hypertension in Patients With Chronic Thromboembolic Pulmonary Disease

TL;DR

The study shows that stress echocardiography can effectively detect exercise-induced pulmonary hypertension in patients with chronic thromboembolic pulmonary disease.

Contribution

This is the first study to validate stress echocardiography as a non-invasive alternative to catheterization for detecting exercise pulmonary hypertension in CTEPD patients.

Findings

Stress echocardiography correlated well with invasive measurements of pulmonary pressure during exercise.

Exercise systolic pulmonary pressure and mPAP/CO slope from echocardiography predicted ePH with high sensitivity and specificity.

Abstract

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).

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).

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%).

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.

ClinicalTrials.gov identifier: NCT03405480

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