RT Journal Article
SR Electronic
T1 Noninvasive evaluation of pulmonary artery pressure during exercise: the importance of right atrial hypertension
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1901617
DO 10.1183/13993003.01617-2019
VO 55
IS 2
A1 Masaru Obokata
A1 Garvan C. Kane
A1 Hidemi Sorimachi
A1 Yogesh N.V. Reddy
A1 Thomas P. Olson
A1 Alexander C. Egbe
A1 Vojtech Melenovsky
A1 Barry A. Borlaug
YR 2020
UL http://erj.ersjournals.com/content/55/2/1901617.abstract
AB 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.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