October 1, 2019Open Access
Etiology of Exercise-Induced Pulmonary Hypertension Can Be Differentiated by Echocardiography ― Insight From Patients With Chronic Pulmonary Thromboembolism With Normal Resting Hemodynamics by Balloon Pulmonary Angioplasty ―
Key Result
In CTEPH patients with near-normal resting hemodynamics after pulmonary angioplasty, resting left atrial volume index was significantly larger in those with exercise-induced occult left ventricular dysfunction.
Study Design
Type
Cross-Sectional (n=71)
Blinding
Blinded analysis of echocardiography images
Multicenter
No
Structured PICO
Can resting echocardiographic indices predict exercise-induced elevation of pulmonary arterial wedge pressure in CTEPH patients with normalized resting hemodynamics after balloon pulmonary angioplasty?
P
Population
71 patients (mean age 67 years, 79% female) with chronic thromboembolic pulmonary hypertension and near-normal resting hemodynamics after balloon pulmonary angioplasty.
E
Exposure
Resting transthoracic echocardiography (specifically measuring Left Atrial Volume Index [LAVi]) combined with symptom-limited supine cycle ergometer exercise test with right heart catheterization.
O
Outcome
Exercise-induced elevation of pulmonary arterial wedge pressure (PAWP >20 mmHg during exercise, defined as occult-left ventricular dysfunction [LVD]) and its correlation with resting echocardiographic indices.surrogate
In CTEPH patients with normalized resting hemodynamics after balloon pulmonary angioplasty, a larger resting left atrial volume index predicts exercise-induced post-capillary pulmonary hypertension (occult left ventricular dysfunction).
Main Result
Absolute Event Rate: 39.7% vs 34.4%
p-value: p=0.017
Limitations
- Did not include patients with high mean PAP at rest or completely normal pulmonary vascular function.
- The interval between echocardiography and right heart catheterization was slightly apart in some patients.
Abstract
BACKGROUND: Exercise-induced pulmonary hypertension (PH) is often seen in chronic thromboembolic PH (CTEPH) patients with normalized resting hemodynamics, but it is difficult to differentiate precapillary PH as pulmonary vascular dysfunction and post-capillary PH from occult-left ventricular dysfunction (LVD). The aim of this study was to examine whether the exercise-induced elevation of pulmonary arterial wedge pressure (PAWP) can be predicted by the echocardiographic index at rest. METHODS AND RESULTS: , P=0.017). LAVi correlated with exercise PAWP (r=0.356, P=0.002), but not resting PAWP (r=0.161, P=0.179). CONCLUSIONS: Larger left atrial volume may reflect the exercise-induced PAWP elevation as occult-LVD in CTEPH patients.