Key result
Exercise Doppler echo with post-exercise TR velocity >3.4 m/s detects PAH with ~91% sensitivity.
Why the study?
With a lower mean PAP cutoff of >20 mmHg proposed for PH, the study examined whether exercise Doppler echocardiography can unmask PAH in SSc patients with equivocal baseline echocardiography.
Does exercise Doppler echocardiography accurately detect pulmonary arterial hypertension in systemic sclerosis patients with equivocal baseline echocardiographic values?
Observational (n=49)
Does exercise Doppler echocardiography accurately detect pulmonary arterial hypertension in systemic sclerosis patients with equivocal baseline echocardiographic values?
Effect estimate: Sensitivity 90.5%, Specificity 80%, Accuracy 84.8%
Exercise Doppler echocardiography provides good diagnostic accuracy for identifying pulmonary arterial hypertension in systemic sclerosis patients with borderline resting echocardiographic measurements.
EDE may identify exercise-induced PAH in SSc with equivocal resting echo; leaves open whether findings alter management or outcomes.
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 (r = 0.571, p < 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.
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Rallidis et al. (2021) conducted an observational in Systemic sclerosis with equivocal baseline echocardiographic values for pulmonary hypertension (n=49). Exercise Doppler echocardiography vs. Right-heart catheterization was evaluated on Detection of pulmonary arterial hypertension (Sensitivity 90.5%, Specificity 80%, Accuracy 84.8%). Exercise Doppler echocardiography with post-exercise TR velocity >3.4 m/s detected pulmonary arterial hypertension with 90.5% sensitivity, 80% specificity, and 84.8% accuracy.
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