Key result
Stress echo mPAP/CO slope is linked to a ~4-fold higher likelihood of exercise pulmonary hypertension.
Why the study?
The ability of stress echocardiography to detect exercise pulmonary hypertension in patients with mild chronic thromboembolic pulmonary disease compared with right-heart catheterization was uncertain.
Does stress echocardiography accurately detect exercise pulmonary hypertension compared to right-heart catheterization in patients with mild chronic thromboembolic pulmonary disease?
Cross-Sectional (n=36)
Does stress echocardiography accurately detect exercise pulmonary hypertension compared to right-heart catheterization in patients with mild chronic thromboembolic pulmonary disease?
Stress echocardiography provides good discrimination and acceptable calibration for detecting exercise pulmonary hypertension in patients with chronic thromboembolic pulmonary disease, offering a promising non-invasive alternative to right-heart catheterization.
Answers are grounded in this paper and cite their sources.
Supports noninvasive PH diagnosis in CTEPD via stress echo; extends its role beyond resting assessment.
Background This study was aimed at determining whether stress echocardiography could detect exercise pulmonary hypertension (ePH) in patients with mild chronic thromboembolic pulmonary disease (CTEPD) as compared with right‐heart catheterization (RHC). Methods Thirty‐six symptomatic patients with persistent residual perfusion defects detected using ventilation/perfusion scintigraphy underwent a haemodynamic assessment by RHC and echocardiography at rest and during exercise. We compared pulmonary pressures in echocardiography with RHC values using the definitions in current ESC/ERS guidelines for ePH [mean pulmonary artery pressure/cardiac output (mPAP/CO) slope > 3 mmHg/L/min] and PH (mPAP > 20 mmHg). Results Ten of the 36 patients (28%) exhibited an increase in the invasive mPAP/CO slope of > 3 mmHg/L/min. The correlation between echocardiographic and invasive measures of the mPAP/CO slope and systolic pulmonary pressure (sPAP) during peak exercise was ρ = 0.75 (95 % C I = 0.53–0.97) and ρ = 0.75 (95 % C I = 0.53–0.96), respectively. In bivariate logistic regression analyses, ePH was associated with the echocardiographic sPAP during peak exercise [ o d d s r a t i o ( OR ) = 1.13, 95 % C I = 1.02–1.24] and with the echocardiographic mPAP/CO slope ( OR = 3.86, 95 % C I = 1.24–12.03). In ROC analysis, AUC was 0.89 (95 % C I = 0.78–1.00) for the optimal exercise sPAP cut‐off value of 56 mmHg ( s e n s i t i v i t y = 90 % , s p e c i f i c i t y = 87 % ), and 0.84 (95 % C I = 0.66–1.00) for the optimal mPAP/CO slope cut‐off value of 3.7 mmHg/L/min ( s e n s i t i v i t y = 89 % , s p e c i f i c i t y = 79 % ). Conclusion Stress echocardiographic assessments of the exercise sPAP and mPAP/CO slope predicted ePH as measured using RHC with good discrimination and acceptable calibration, providing promising evidence in diagnosing ePH in patients with CTEPD. Trial Registration ClinicalTrials.gov identifier: NCT03405480
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Dhayyat et al. (2026) conducted a cross-sectional in Mild chronic thromboembolic pulmonary disease (CTEPD) (n=36). Stress echocardiography vs. Right-heart catheterization (RHC) was evaluated on Exercise pulmonary hypertension (ePH) defined as mPAP/CO slope > 3 mmHg/L/min (OR 3.86, 95% CI 1.24-12.03). Stress echocardiographic assessment of the mPAP/CO slope predicted exercise pulmonary hypertension measured by right-heart catheterization.
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