Systolic pulmonary artery pressure assessed during routine exercise Doppler echocardiography: insights of a real-world setting in patients with elevated pulmonary pressures

Abstract

Pulmonary hypertension is a marker of disease severity. Exercise Doppler echocardiography (EDE) has proven to be feasible and reliable to assess pulmonary pressure. Increase in systolic pulmonary artery pressure (sPAP) has diagnostic and prognostic value in controlled studies. However, its value when assessed during routine examination in patients with cardiopulmonary diseases and resting sPAP > 35 mmHg is not clearly defined. Clinical documentation and offline reevaluation of digitally stored EDE examinations of patients with appropriate clinical indications for EDE were analyzed. N = 278 patients with sPAP at rest > 35 mmHg met inclusion criteria. One patient was lost to follow-up. Mean age of patients was 72 ± 10 years, 178 (64%) of the study population were men. There were no relevant differences among survivors and non-survivors concerning comorbidities. Exercise performance (3.6 ± 1.2 vs. 4.9 ± 1.4 MET, p < 0.001) was lower, whereas sPAP during exercise was higher (67.3 ± 14.7 vs. 62.1 ± 13.2 mmHg, p = 0.027) in non-survivors. Univariate predictors of all-cause mortality were NYHA functional class III (HR = 2.56, p < 0.001), ≥ 2-vessels coronary artery disease (CAD) (HR = 1.93, p = 0.04), left atrial diameter > 45 mm (HR = 2.58, p < 0.001), rest sPAP > 42 mmHg (HR = 1.94, p = 0.010) and ΔsPAP increase ≥ 0.23 mmHg/Watt (HF = 1.92, p = 0.010). After multivariate analysis, NYHA functional class III (HR = 2.35, p < 0.001), LA diameter (HR = 2.28, p = 0.003) and sPAP increase ≥ 0.23 mmHg/Watt (HF = 2.19, p = 0.002) remained significant predictors of mortality, whereas a double product (HR = 0.42, p = 0.005) was associated with better prognosis. sPAP assessment during routine EDE provides relevant prognostic information comparable to findings in studies in selected populations. A higher sPAP increase at lower exercise performance shows significant association with increased of mortality.

Aktuelle Definition und Diagnostik der pulmonalen Hypertonie

“…Jüngste Vergleiche zwischen Stressechokardiografie und RHK unter Belastung bestätigen eine Ungenauigkeit der nicht-invasiven Methode [122]. Zu beachten ist, dass ein pulmonalarterieller Druckanstieg unter Belastung jedoch in Abhängigkeit vom untersuchten Patientenkollektiv mit einer besseren (als Surrogat der RV-Funktion bei PAH und CTEPH) oder schlechteren Prognose (als Ausdruck der Schwere einer Linksherzerkrankung) einhergehen kann [123,124]. Die echokardiografische Beurteilung unter laufender PAH-Therapie kann zukünftig eine Bedeutung bei der Verlaufskontrolle erhalten, wobei hier noch Validierungsstudien notwendig sind [125].…”

Sex difference in pulmonary hypertension in the evaluation by exercise echocardiography

“…Korff et al reported conflicting results; a higher TRPG increase during exercise may be a predictor of MACE in patients with any heart disease. 29 They analyzed 278 patients with PASP at rest > 35 mmHg who underwent exercise echocardiography and evaluated the increase in TRPG during exercise. They included patients mainly with ischemic heart disease (49.1%) and valvular disease (22.4%), and their PASPs were moderately increased (rest PASP, 45 mmHg).…”

“…Korff et al reported conflicting results; a higher TRPG increase during exercise may be a predictor of MACE in patients with any heart disease 29 . They analyzed 278 patients with PASP at rest > 35 mmHg who underwent exercise echocardiography and evaluated the increase in TRPG during exercise.…”