1. Accuracy of Echocardiography to Estimate Pulmonary Artery Pressures With Exercise
- Author
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Berto J. Bouma, Jose Rivero, Alexander R. Opotowsky, Annelieke C.M.J. van Riel, Aaron B. Waxman, David M. Systrom, Mário Santos, Amil M. Shah, Barbara J.M. Mulder, Michael J. Landzberg, Andy Dhimitri, Cardiology, APH - Personalized Medicine, APH - Aging & Later Life, Amsterdam Cardiovascular Sciences, ACS - Heart failure & arrhythmias, and ACS - Pulmonary hypertension & thrombosis
- Subjects
Male ,medicine.medical_specialty ,Haemodynamic response ,Hypertension, Pulmonary ,Regurgitation (circulation) ,Pulmonary Artery ,030204 cardiovascular system & hematology ,Patient Positioning ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Predictive Value of Tests ,medicine.artery ,Internal medicine ,medicine ,Humans ,Arterial Pressure ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,Exercise Tolerance ,business.industry ,Area under the curve ,Reproducibility of Results ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Echocardiography, Doppler ,Tricuspid Valve Insufficiency ,Confidence interval ,Editorial ,Blood pressure ,ROC Curve ,030228 respiratory system ,Area Under Curve ,Catheterization, Swan-Ganz ,Pulmonary artery ,Exercise Test ,symbols ,Cardiology ,Female ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,business ,Doppler effect ,Echocardiography, Stress - Abstract
Background— Exercise echocardiography is often applied as a noninvasive strategy to screen for abnormal pulmonary hemodynamic response, but it is technically challenging, and limited data exist regarding its accuracy to estimate pulmonary arterial pressure during exercise. Methods and Results— Among 65 patients with exertional intolerance undergoing upright invasive exercise testing, tricuspid regurgitation (TR) Doppler estimates and invasive measurement of pulmonary arterial pressure at rest and peak exercise were simultaneously obtained. TR Doppler envelopes were assessed for quality. Correlation, Bland–Altman, and receiver-operating characteristic curve analyses were performed to evaluate agreement and diagnostic accuracy. Mean age was 62±13 years, and 31% were male. High-quality (grade A) TR Doppler was present in 68% at rest and 34% at peak exercise. For grade A TR signals, echocardiographic measures of systolic pulmonary arterial pressure correlated reasonably well with invasive measurement at rest ( r =0.72, P r =0.75, P 3.0 mm Hg/L per minute increase), with 91% sensitivity and 82% specificity (area under the curve, 0.90; 95% confidence interval, 0.77–1.0; P =0.001). Conclusions— Agreement between echocardiographic and invasive measures of pulmonary pressures during upright exercise is good among the subset of patients with high-quality TR Doppler signal. While the limits of agreement are broad, our results suggest that in those patients, sensitivity is adequate to screen for abnormal pulmonary hemodynamic response during exercise.
- Published
- 2017
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