Exercise echocardiography accurately identified abnormal pulmonary hemodynamic response in patients with high-quality Doppler signals (AUC 0.90; 95% CI 0.77-1.0; P=0.001).
Cross-Sectional (n=65)
Does echocardiography accurately estimate pulmonary arterial pressure compared to invasive measurement during exercise in patients with exertional intolerance?
Exercise echocardiography provides good diagnostic accuracy for estimating pulmonary artery pressures and identifying abnormal hemodynamic responses, but only in the subset of patients with high-quality tricuspid regurgitation Doppler signals.
Effect estimate: AUC 0.90 (95% CI 0.77-1.0)
p-value: p=0.001
Background— Exercise echocardiography is often applied as a noninvasive strategy to screen for abnormal pulmonary hemodynamic response, but it is technically challenging, and limited data exist regarding its accuracy to estimate pulmonary arterial pressure during exercise. Methods and Results— Among 65 patients with exertional intolerance undergoing upright invasive exercise testing, tricuspid regurgitation (TR) Doppler estimates and invasive measurement of pulmonary arterial pressure at rest and peak exercise were simultaneously obtained. TR Doppler envelopes were assessed for quality. Correlation, Bland–Altman, and receiver-operating characteristic curve analyses were performed to evaluate agreement and diagnostic accuracy. Mean age was 62±13 years, and 31% were male. High-quality (grade A) TR Doppler was present in 68% at rest and 34% at peak exercise. For grade A TR signals, echocardiographic measures of systolic pulmonary arterial pressure correlated reasonably well with invasive measurement at rest ( r =0.72, P 3.0 mm Hg/L per minute increase), with 91% sensitivity and 82% specificity (area under the curve, 0.90; 95% confidence interval, 0.77–1.0; P =0.001). Conclusions— Agreement between echocardiographic and invasive measures of pulmonary pressures during upright exercise is good among the subset of patients with high-quality TR Doppler signal. While the limits of agreement are broad, our results suggest that in those patients, sensitivity is adequate to screen for abnormal pulmonary hemodynamic response during exercise.
Riel et al. (Fri,) conducted a cross-sectional in exertional intolerance (n=65). Exercise echocardiography (TR Doppler) vs. Invasive measurement of pulmonary arterial pressure was evaluated on Identification of abnormal pulmonary hemodynamic response during exercise (AUC 0.90, 95% CI 0.77-1.0, p=0.001). Exercise echocardiography accurately identified abnormal pulmonary hemodynamic response in patients with high-quality Doppler signals (AUC 0.90; 95% CI 0.77-1.0; P=0.001).