Cardiopulmonary exercise test to detect cardiac dysfunction from pulmonary vascular disease

Background Cardiac dysfunction from pulmonary vascular disease causes characteristic findings on cardiopulmonary exercise testing (CPET). We tested the accuracy of CPET for detecting inadequate stroke volume (SV) augmentation during exercise, a pivotal manifestation of cardiac limitation in patients with pulmonary vascular disease. Methods We reviewed patients with suspected pulmonary vascular disease in whom CPET and right heart catheterization (RHC) measurements were taken at rest and at anaerobic threshold (AT). We correlated CPET-determined $ O_{2} $·$ pulse_{AT} $/$ O_{2} $·$ pulse_{rest} $ with RHC-determined $ SV_{AT} $/$ SV_{rest} $. We evaluated the sensitivity and specificity of $ O_{2} $·$ pulse_{AT} $/$ O_{2} $·$ pulse_{rest} $ to detect $ SV_{AT} $/$ SV_{rest} $ below the lower limit of normal (LLN). For comparison, we performed similar analyses comparing echocardiographically-measured peak tricuspid regurgitant velocity ($ TRV_{peak} $) with $ SV_{AT} $/$ SV_{rest} $. Results From July 2018 through February 2023, 83 simultaneous RHC and CPET were performed. Thirty-six studies measured $ O_{2} $·pulse and SV at rest and at AT. $ O_{2} $·$ pulse_{AT} $/$ O_{2} $·$ pulse_{rest} $ correlated highly with $ SV_{AT} $/$ SV_{rest} $ (r = 0.72, 95% CI 0.52, 0.85; p < 0.0001), whereas $ TRV_{peak} $ did not (r = -0.09, 95% CI -0.47, 0.33; p = 0.69). The AUROC to detect $ SV_{AT} $/$ SV_{rest} $ below the LLN was significantly higher for $ O_{2} $·$ pulse_{AT} $/$ O_{2} $·$ pulse_{rest} $ (0.92, SE 0.04; p = 0.0002) than for $ TRV_{peak} $ (0.69, SE 0.10; p = 0.12). $ O_{2} $·$ pulse_{AT} $/$ O_{2} $·$ pulse_{rest} $ of less than 2.6 was 92.6% sensitive (95% CI 76.6%, 98.7%) and 66.7% specific (95% CI 35.2%, 87.9%) for deficient $ SV_{AT} $/$ SV_{rest} $. Conclusions CPET detected deficient SV augmentation more accurately than echocardiography. CPET-determined $ O_{2} $·$ pulse_{AT} $/$ O_{2} $·$ pulse_{rest} $ may have a prominent role for noninvasive screening of patients at risk for pulmonary vascular disease, such as patients with persistent dyspnea after pulmonary embolism..

Medienart:	E-Artikel

Erscheinungsjahr:	2024
Erschienen:	2024

Enthalten in:	Zur Gesamtaufnahme - volume:25
Enthalten in:	Respiratory research - 25(2024), 1 vom: 11. März

Sprache:	Englisch

Beteiligte Personen:	Alotaibi, Mona [VerfasserIn] Yang, Jenny Z. [VerfasserIn] Papamatheakis, Demosthenes G. [VerfasserIn] McGuire, W. Cameron [VerfasserIn] Fernandes, Timothy M. [VerfasserIn] Morris, Timothy A. [VerfasserIn]

Links:	Volltext [kostenfrei]

BKL:	44.00
Themen:	Cardiopulmonary exercise test (CPET) Echocardiography Pulmonary embolism Pulmonary vascular disease Stroke volume augmentation

Anmerkungen:	© The Author(s) 2024

doi:	10.1186/s12931-024-02746-w

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	SPR055106021