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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/21563

Title: Accuracy of Echocardiography to Evaluate Pulmonary Vascular and RV Function During Exercise
Authors: Claessen, Guido
La Gerche, Andre
Voigt, Jens-Uwe
Dymarkowski, Steven
Schnell, Frederic
Petit, Thibault
Willems, Rik
Claus, Piet
Delcroix, Marion
Heidbuchel, Hein
Issue Date: 2016
Publisher: ELSEVIER SCIENCE INC
Citation: JACC-CARDIOVASCULAR IMAGING, 9 (5), p. 532-543
Abstract: OBJECTIVES The authors have compared exercise echocardiography and exercise cardiac magnetic resonance imaging with simultaneous invasive pressure registration (ExCMR(ip)) for the assessment of pulmonary vascular and right ventricular (RV) function. BACKGROUND Exercise echocardiography may enable early diagnosis of pulmonary vascular disease, but its accuracy is untested. METHODS Exercise imaging was performed in 61 subjects (19 athletes, 9 healthy nonathletes, 8 healthy BMPR2 [bone morphogenetic protein receptor type II] mutation carriers, 5 patients with new or worsening dyspnea after acute pulmonary embolism, and 20 patients with chronic thromboembolic pulmonary hypertension). Echocardiographic variables included mean pulmonary artery pressure (mPAP) and systolic pulmonary artery pressure (sPAP), cardiac output (CO), RV fractional area change, tricuspid annular systolic excursion, and RV end-systolic pressure-area ratio as a surrogate measure of RV contractile reserve. ExCMR(ip) provided measurements of CO, RV ejection fraction, mPAP, sPAP, and RV end-systolic pressure-volume ratio at rest and during exercise. Abnormal pulmonary vascular reserve was defined as mPAP/CO slope >3 mm Hg/l/min by ExCMR(ip). RESULTS Echocardiographic determination of mPAP/CO was possible in 53 of 61 subjects (87%). mPAP/CO by echocardiography was higher than that obtained by ExCMR(ip) (+0.9 mm Hg/l/min; 95% limits of agreement, -3.6 to 5.4), but enabled accurate identification of patients with abnormal pulmonary vascular reserve (area under the receiver-operating characteristic curve, 0.88 [95% confidence interval (CI): 0.77 to 1.00; p < 0.0001]). Simplified relationships between sPAP and exercise intensity had similar accuracy in identifying subjects with pulmonary vascular disease (area under the receiver-operating characteristic curve, 0.95 [95% CI: 0.88 to 1.01]; p < 0.0001). RV fractional area change by echocardiography correlated strongly with RV ejection fraction by ExCMR(ip), whereas a moderate correlation was found between tricuspid annular systolic excursion and RV ejection fraction. A moderate correlation was found between ratios of peak exercise to resting RV end-systolic pressure-area ratio and RV end-systolic pressurevolume ratio (r = 0.64; p < 0.0001). CONCLUSIONS Echocardiographic estimates of RV and pulmonary vascular function are feasible during exercise and identify pathology with reasonable accuracy. They represent valid screening tools for the identification of pulmonary vascular disease in routine clinical practice. (C) 2016 by the American College of Cardiology Foundation.
Notes: [Claessen, Guido; La Gerche, Andre; Voigt, Jens-Uwe; Schnell, Frederic; Petit, Thibault; Willems, Rik; Claus, Piet] Katholieke Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium. [Claessen, Guido; Voigt, Jens-Uwe; Dymarkowski, Steven; Petit, Thibault; Willems, Rik; Delcroix, Marion] Univ Hosp Leuven, Herestr 49, B-3000 Leuven, Belgium. [La Gerche, Andre] Baker IDI Heart & Diabet Inst, Melbourne, Vic, Australia. [Dymarkowski, Steven] Katholieke Univ Leuven, Dept Imaging & Pathol, Leuven, Belgium. [Schnell, Frederic] Rennes Univ, Dept Physiol, Rennes, France. [Delcroix, Marion] Katholieke Univ Leuven, Dept Clin & Expt Med, Leuven, Belgium. [Heidbuchel, Hein] Univ Hasselt, Hasselt, Belgium. [Heidbuchel, Hein] Jessa Hosp, Ctr Heart, Hasselt, Belgium.
URI: http://hdl.handle.net/1942/21563
DOI: 10.1016/j.jcmg.2015.06.018
ISI #: 000375597700005
ISSN: 1936-878X
Category: A1
Type: Journal Contribution
Appears in Collections: Research publications

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