The Role of Exercise Doppler Echocardiography to Unmask Pulmonary Arterial Hypertension in Selected Patients with Systemic Sclerosis and Equivocal Baseline Echocardiographic Values for Pulmonary Hypertension
Recently, a lower mean pulmonary arterial pressure (PAP) cutoff of >20 mmHg for pulmonary hypertension (PH) definition has been proposed. We examined whether exercise Doppler echocardiography (EDE) can unmask PA hypertension (PAH) in systemic sclerosis (SSc) patients whose baseline echocardiograp...
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MDPI AG
2021-07-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/11/7/1200 |
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| author | Loukianos S. Rallidis Konstantina Papangelopoulou Anastasia Anthi Iraklis Tsangaris Christos Varounis Georgios Makavos Dimitrios Konstantonis Panagiotis Vlachoyiannopoulos Stylianos E. Orfanos Efstathios K. Iliodromitis |
| author_facet | Loukianos S. Rallidis Konstantina Papangelopoulou Anastasia Anthi Iraklis Tsangaris Christos Varounis Georgios Makavos Dimitrios Konstantonis Panagiotis Vlachoyiannopoulos Stylianos E. Orfanos Efstathios K. Iliodromitis |
| author_sort | Loukianos S. Rallidis |
| collection | DOAJ |
| description | Recently, a lower mean pulmonary arterial pressure (PAP) cutoff of >20 mmHg for pulmonary hypertension (PH) definition has been proposed. We examined whether exercise Doppler echocardiography (EDE) can unmask PA hypertension (PAH) in systemic sclerosis (SSc) patients whose baseline echocardiography for PH is equivocal. We enrolled 49 patients with SSc who underwent treadmill EDE. Tricuspid regurgitation (TR) velocity was recorded immediately after EDE. Inotropic reserve of right ventricle (RV) was assessed by the change (post-prior to exercise) of tissue Doppler imaging-derived peak systolic velocity (S) of tricuspid annulus. Inclusion criteria comprised preserved left and RV function, and baseline TR velocity between 2.7 and 3.2 m/s. All patients had right-heart catheterization (RHC) within 48 h after EDE. From 46 patients with good quality of post-exercise TR velocity, RHC confirmed PAH in 21 (45.6%). Post-exercise TR velocity >3.4 m/s had a sensitivity of 90.5%, a specificity of 80% and an accuracy of 84.8% in detecting PAH. Inotropic reserve of RV was positively correlated with maximum achieved workload in METs (<i>r</i> = 0.571, <i>p</i> < 0.001). EDE has a good diagnostic accuracy for the identification of PAH in selected SSc patients whose baseline echocardiographic measurements for PH lie in the gray zone, and it is also potentially useful in assessing RV contractile reserve. |
| first_indexed | 2024-03-10T09:42:07Z |
| format | Article |
| id | doaj.art-6514f8e5e990426b97932798bc9d6b46 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T09:42:07Z |
| publishDate | 2021-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-6514f8e5e990426b97932798bc9d6b462023-11-22T03:34:12ZengMDPI AGDiagnostics2075-44182021-07-01117120010.3390/diagnostics11071200The Role of Exercise Doppler Echocardiography to Unmask Pulmonary Arterial Hypertension in Selected Patients with Systemic Sclerosis and Equivocal Baseline Echocardiographic Values for Pulmonary HypertensionLoukianos S. Rallidis0Konstantina Papangelopoulou1Anastasia Anthi2Iraklis Tsangaris3Christos Varounis4Georgios Makavos5Dimitrios Konstantonis6Panagiotis Vlachoyiannopoulos7Stylianos E. Orfanos8Efstathios K. Iliodromitis9Second Department of Cardiology and Pulmonary Hypertension Clinic, School of Medicine, National & Kapodistrian University of Athens, Attikon Hospital, 16462 Athens, GreeceSecond Department of Cardiology and Pulmonary Hypertension Clinic, School of Medicine, National & Kapodistrian University of Athens, Attikon Hospital, 16462 Athens, GreeceSecond Department of Critical Care and Pulmonary Hypertension Clinic, School of Medicine, National & Kapodistrian University of Athens, Attikon Hospital, 16462 Athens, GreeceSecond Department of Critical Care and Pulmonary Hypertension Clinic, School of Medicine, National & Kapodistrian University of Athens, Attikon Hospital, 16462 Athens, GreeceSecond Department of Cardiology and Pulmonary Hypertension Clinic, School of Medicine, National & Kapodistrian University of Athens, Attikon Hospital, 16462 Athens, GreeceSecond Department of Cardiology and Pulmonary Hypertension Clinic, School of Medicine, National & Kapodistrian University of Athens, Attikon Hospital, 16462 Athens, GreeceSecond Department of Critical Care and Pulmonary Hypertension Clinic, School of Medicine, National & Kapodistrian University of Athens, Attikon Hospital, 16462 Athens, GreeceDepartment of Pathophysiology, School of Medicine, National & Kapodistrian University of Athens, 11527 Athens, GreeceSecond Department of Critical Care and Pulmonary Hypertension Clinic, School of Medicine, National & Kapodistrian University of Athens, Attikon Hospital, 16462 Athens, GreeceSecond Department of Cardiology and Pulmonary Hypertension Clinic, School of Medicine, National & Kapodistrian University of Athens, Attikon Hospital, 16462 Athens, GreeceRecently, a lower mean pulmonary arterial pressure (PAP) cutoff of >20 mmHg for pulmonary hypertension (PH) definition has been proposed. We examined whether exercise Doppler echocardiography (EDE) can unmask PA hypertension (PAH) in systemic sclerosis (SSc) patients whose baseline echocardiography for PH is equivocal. We enrolled 49 patients with SSc who underwent treadmill EDE. Tricuspid regurgitation (TR) velocity was recorded immediately after EDE. Inotropic reserve of right ventricle (RV) was assessed by the change (post-prior to exercise) of tissue Doppler imaging-derived peak systolic velocity (S) of tricuspid annulus. Inclusion criteria comprised preserved left and RV function, and baseline TR velocity between 2.7 and 3.2 m/s. All patients had right-heart catheterization (RHC) within 48 h after EDE. From 46 patients with good quality of post-exercise TR velocity, RHC confirmed PAH in 21 (45.6%). Post-exercise TR velocity >3.4 m/s had a sensitivity of 90.5%, a specificity of 80% and an accuracy of 84.8% in detecting PAH. Inotropic reserve of RV was positively correlated with maximum achieved workload in METs (<i>r</i> = 0.571, <i>p</i> < 0.001). EDE has a good diagnostic accuracy for the identification of PAH in selected SSc patients whose baseline echocardiographic measurements for PH lie in the gray zone, and it is also potentially useful in assessing RV contractile reserve.https://www.mdpi.com/2075-4418/11/7/1200exercise Doppler echocardiographypulmonary arterial hypertensionsystemic sclerosis |
| spellingShingle | Loukianos S. Rallidis Konstantina Papangelopoulou Anastasia Anthi Iraklis Tsangaris Christos Varounis Georgios Makavos Dimitrios Konstantonis Panagiotis Vlachoyiannopoulos Stylianos E. Orfanos Efstathios K. Iliodromitis The Role of Exercise Doppler Echocardiography to Unmask Pulmonary Arterial Hypertension in Selected Patients with Systemic Sclerosis and Equivocal Baseline Echocardiographic Values for Pulmonary Hypertension Diagnostics exercise Doppler echocardiography pulmonary arterial hypertension systemic sclerosis |
| title | The Role of Exercise Doppler Echocardiography to Unmask Pulmonary Arterial Hypertension in Selected Patients with Systemic Sclerosis and Equivocal Baseline Echocardiographic Values for Pulmonary Hypertension |
| title_full | The Role of Exercise Doppler Echocardiography to Unmask Pulmonary Arterial Hypertension in Selected Patients with Systemic Sclerosis and Equivocal Baseline Echocardiographic Values for Pulmonary Hypertension |
| title_fullStr | The Role of Exercise Doppler Echocardiography to Unmask Pulmonary Arterial Hypertension in Selected Patients with Systemic Sclerosis and Equivocal Baseline Echocardiographic Values for Pulmonary Hypertension |
| title_full_unstemmed | The Role of Exercise Doppler Echocardiography to Unmask Pulmonary Arterial Hypertension in Selected Patients with Systemic Sclerosis and Equivocal Baseline Echocardiographic Values for Pulmonary Hypertension |
| title_short | The Role of Exercise Doppler Echocardiography to Unmask Pulmonary Arterial Hypertension in Selected Patients with Systemic Sclerosis and Equivocal Baseline Echocardiographic Values for Pulmonary Hypertension |
| title_sort | role of exercise doppler echocardiography to unmask pulmonary arterial hypertension in selected patients with systemic sclerosis and equivocal baseline echocardiographic values for pulmonary hypertension |
| topic | exercise Doppler echocardiography pulmonary arterial hypertension systemic sclerosis |
| url | https://www.mdpi.com/2075-4418/11/7/1200 |
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