Document Detail


Assessment of pulmonary arterial pressure during exercise in collagen vascular disease: echocardiography vs right-sided heart catheterization.
MedLine Citation:
PMID:  20418368     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: This study compared the results of exercise Doppler echocardiography (EDE) with right-sided heart catheterization (RHC) and evaluated the combination of EDE and cardiopulmonary exercise testing (CPET) as a screening method for early pulmonary vasculopathy in patients with connective tissue disease.
METHODS: Patients (N = 52) with connective tissue disease (predominantly systemic sclerosis) and without known pulmonary arterial hypertension underwent both EDE and CPET. If systolic pulmonary arterial pressure (SPAP) was > 40 mm Hg during exercise or peak oxygen uptake (Vo(2)) was < 75% predicted, RHC was suggested.
RESULTS: EDE showed an SPAP > 40 mm Hg during exercise in 26/52 patients. Additionally, CPET showed a peak Vo(2) < 75% predicted in 10/26 patients with SPAP <or= 40 mm Hg upon exercise. Accordingly, RHC was suggested to 36 patients. RHC was performed in 28 of these patients, revealing SPAP > 40 mm Hg in 25 patients (n = 1 at rest, n = 24 during exercise). SPAP values assessed by EDE showed no significant difference vs RHC at rest, 25 W, 50 W, and maximal exercise (difference [95% CI]: 0.3 [-2.7; 3.2], -1.3 [-7.1; 4.4], 0.9 [-7.7; 5.9], and -5.6 [-13.5; 2.2] mm Hg). Eight patients with exercise SPAP > 40 mm Hg had an exercise pulmonary arterial wedge pressure > 20 mm Hg, suggesting exercise-induced left ventricular diastolic dysfunction not detectable by EDE.
CONCLUSIONS: EDE appears to be a reasonable noninvasive method to detect SPAP increase during exercise in connective tissue disease. In combination with CPET, it may be a useful screening tool for early pulmonary vasculopathy, although RHC remains the gold standard for hemodynamic assessment.
TRIAL REGISTRATION: clinicaltrials.gov; Identifier: NCT00609349 (Early Recognition of Pulmonary Arterial Hypertension).
Authors:
Gabor Kovacs; Robert Maier; Elisabeth Aberer; Marianne Brodmann; Stefan Scheidl; Christian Hesse; Natascha Troester; Wolfgang Salmhofer; Rudolf Stauber; Florentine C Fuerst; Rene Thonhofer; Petra Ofner-Kopeinig; Ekkehard Gruenig; Horst Olschewski
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-04-23
Journal Detail:
Title:  Chest     Volume:  138     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-04     Completed Date:  2010-08-19     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  270-8     Citation Subset:  AIM; IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00609349
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Pressure
Cardiac Catheterization*
Connective Tissue Diseases / complications*
Echocardiography, Doppler*
Exercise Test
Female
Humans
Hypertension, Pulmonary / diagnosis*,  etiology
Male
Mass Screening
Middle Aged
Pulmonary Artery / physiopathology*
Comments/Corrections
Comment In:
Chest. 2010 Dec;138(6):1523-4; author reply 1524   [PMID:  21138893 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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