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

  • Susanne Korff
  • Patricia Enders-Gier
  • Lorenz Uhlmann
  • Matthias Aurich
  • Sebastian Greiner
  • Kristof Hirschberg
  • Hugo A. Katus
  • Derliz Mereles
Original Paper

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.

Keywords

Exercise Doppler echocardiography Heart failure Pulmonary hypertension 

Abbreviations

BMI

Body mass index

CAD

Coronary artery disease

DP

Double product

EDE

Exercise Doppler echocardiography

EF

Ejection fraction

HFrEF

Heart failure with reduced ejection fraction

HFmrEF

Heart failure with mid-range ejection fraction

HFpEF

Heart failure with preserved ejection fraction

LA

Left atrium

LV

Left ventricle

MET

Metabolic equivalent of task

NYHA

New York Heart Association functional class

PAH

Pulmonary arterial hypertension

PH

Pulmonary hypertension

RAP

Right atrial pressure

RVsΔP

Right ventricular peak systolic pressure gradient

sPAP

Systolic pulmonary artery pressure

sPAP Max

sPAP at peak exercise

ΔsPAP

Relative sPAP change at rest vs. exercise

WHO

World Health Organization

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the Ethics Committee of the University of Heidelberg and in concordance with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal Medicine III, CardiologyAngiology and PneumologyHeidelbergGermany
  2. 2.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany

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