Reduced pulmonary vascular reserve during stress echocardiography in confirmed pulmonary hypertension and patients at risk of overt pulmonary hypertension.

Szczegóły
Abstrakt

Tytuł:: Reduced pulmonary vascular reserve during stress echocardiography in confirmed pulmonary hypertension and patients at risk of overt pulmonary hypertension.
Autorzy:: Wierzbowska-Drabik K; I Department and Chair of Cardiology, Medical University of Lodz, Bieganski Hospital, Lodz, Poland. .
Kasprzak JD; I Department and Chair of Cardiology, Medical University of Lodz, Bieganski Hospital, Lodz, Poland.
D Alto M; Department of Cardiology, University 'L. Vanvitelli'- AORN dei Colli - Monaldi Hospital, Naples, Italy.
Ágoston G; Department of Family Medicine, University of Szeged, Tisza Lajos krt. 109, Szeged, 6725, Hungary.
Varga A; Department of Family Medicine, University of Szeged, Tisza Lajos krt. 109, Szeged, 6725, Hungary.
Ferrara F; Cardiology Division, Heart Department, University Hospital of Salerno, 'Cava de' Tirreni and Amalfi Coast' Hospital, Salerno, Italy.
Amor M; Cardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina.
Ciampi Q; Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy.
Bossone E; AORN A. Cardarelli Hospital, Naples, Italy.
Picano E; Institute of Clinical Physiology - C.N.R., Pisa, Italy.
Źródło:: The international journal of cardiovascular imaging [Int J Cardiovasc Imaging] 2020 Oct; Vol. 36 (10), pp. 1831-1843. Date of Electronic Publication: 2020 May 27.
Typ publikacji:: Comparative Study; Journal Article; Multicenter Study
Język:: English
Imprint Name(s):: Publication: [New York] : Springer
Original Publication: Boston : Kluwer Academic Publishers, c2001-
MeSH Terms:: Echocardiography, Doppler*
Echocardiography, Stress*
Exercise Test*
Hemodynamics*
Pulmonary Circulation*
Hypertension, Pulmonary/*diagnostic imaging
Pulmonary Artery/*diagnostic imaging
Adult ; Aged ; Aged, 80 and over ; Arterial Pressure ; Cardiac Output ; Case-Control Studies ; Europe ; Exercise Tolerance ; Feasibility Studies ; Female ; Humans ; Hypertension, Pulmonary/physiopathology ; Male ; Middle Aged ; Predictive Value of Tests ; Pulmonary Artery/physiopathology ; Time Factors ; Young Adult
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Contributed Indexing:: Keywords: Pulmonary acceleration time; Pulmonary hypertension; Pulmonary vascular reserve; Stress echocardiography; Tricuspid regurgitant velocity
Entry Date(s):: Date Created: 20200529 Date Completed: 20200928 Latest Revision: 20211222
Update Code:: 20240105
PubMed Central ID:: PMC7497494
DOI:: 10.1007/s10554-020-01897-3
PMID:: 32462450
: Czasopismo naukowe

Noninvasive estimation of systolic pulmonary artery pressure (SPAP) during exercise stress echocardiography (ESE) is recommended for pulmonary hemodynamics evaluation but remains flow-dependent. Our aim was to assess the feasibility of pulmonary vascular reserve index (PVRI) estimation during ESE combining SPAP with cardiac output (CO) or exercise-time and compare its value in three group of patients: with invasively confirmed pulmonary hypertension (PH), at risk of PH development (PH risk) mainly with systemic sclerosis and in controls (C) without clinical risk factors for PH, age-matched with PH risk patients. We performed semisupine ESE in 171 subjects: 31 PH, 61 PH at risk and 50 controls as well as in 29 young, healthy normals. Rest and stress assessment included: tricuspid regurgitant flow velocity (TRV), pulmonary acceleration time (ACT), CO (Doppler-estimated). SPAP was calculated from TRV or ACT when TRV was not available. We estimated PVRI based on CO (peak CO/SPAP*0.1) or exercise-time (ESE time/SPAP*0.1). During stress, TRV was measurable in 44% patients ACT in 77%, either one in 95%. PVRI was feasible in 65% subjects with CO and 95% with exercise-time (p < 0.0001). PVRI was lower in PH compared to controls both for CO-based PVRI (group 1 = 1.0 ± 0.95 vs group 3 = 4.28 ± 2.3, p < 0.0001) or time-based PVRI estimation (0.66 ± 0.39 vs 3.95 ± 2.26, p < 0.0001). The proposed criteria for PH detection were for CO-based PVRI ≤ 1.29 and ESE-time based PVRI ≤ 1.0 and for PH risk ≤ 1.9 and ≤ 1.7 respectively. Noninvasive estimation of PVRI can be obtained in near all patients during ESE, without contrast administration, integrating TRV with ACT for SPAP assessment and using exercise time as a proxy of CO. These indices allow for comparison of pulmonary vascular dynamics in patients with varied exercise tolerance and clinical status.

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