Systolic pulmonary artery pressure assessed during routine exercise Doppler echocardiography: insights of a real-world setting in patients with elevated pulmonary pressures
| Autor: | Susanne Korff, Sebastian Greiner, Lorenz Uhlmann, Patricia Enders-Gier, Hugo A. Katus, Matthias Aurich, Kristóf Hirschberg, Derliz Mereles |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Multivariate analysis Systole Hypertension Pulmonary 030204 cardiovascular system & hematology Doppler echocardiography Pulmonary Artery 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests medicine.artery Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Arterial Pressure 030212 general & internal medicine Cardiopulmonary disease Aged Aged 80 and over Watt medicine.diagnostic_test business.industry Middle Aged medicine.disease Pulmonary hypertension Echocardiography Doppler Heart failure Pulmonary artery Cardiology Exercise Test Population study Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The international journal of cardiovascular imaging. 34(8) |
| ISSN: | 1875-8312 |
| Popis: | Pulmonary hypertension is a marker of disease severity. Exercise Doppler echocardiography (EDE) has proven to be feasible and reliable to assess pulmonary pressure. Increase in systolic pulmonary artery pressure (sPAP) has diagnostic and prognostic value in controlled studies. However, its value when assessed during routine examination in patients with cardiopulmonary diseases and resting sPAP 35 mmHg is not clearly defined. Clinical documentation and offline reevaluation of digitally stored EDE examinations of patients with appropriate clinical indications for EDE were analyzed. N = 278 patients with sPAP at rest 35 mmHg met inclusion criteria. One patient was lost to follow-up. Mean age of patients was 72 ± 10 years, 178 (64%) of the study population were men. There were no relevant differences among survivors and non-survivors concerning comorbidities. Exercise performance (3.6 ± 1.2 vs. 4.9 ± 1.4 MET, p 0.001) was lower, whereas sPAP during exercise was higher (67.3 ± 14.7 vs. 62.1 ± 13.2 mmHg, p = 0.027) in non-survivors. Univariate predictors of all-cause mortality were NYHA functional class III (HR = 2.56, p 0.001), ≥ 2-vessels coronary artery disease (CAD) (HR = 1.93, p = 0.04), left atrial diameter 45 mm (HR = 2.58, p 0.001), rest sPAP 42 mmHg (HR = 1.94, p = 0.010) and ΔsPAP increase ≥ 0.23 mmHg/Watt (HF = 1.92, p = 0.010). After multivariate analysis, NYHA functional class III (HR = 2.35, p 0.001), LA diameter (HR = 2.28, p = 0.003) and sPAP increase ≥ 0.23 mmHg/Watt (HF = 2.19, p = 0.002) remained significant predictors of mortality, whereas a double product (HR = 0.42, p = 0.005) was associated with better prognosis. sPAP assessment during routine EDE provides relevant prognostic information comparable to findings in studies in selected populations. A higher sPAP increase at lower exercise performance shows significant association with increased of mortality. |
| Databáze: | OpenAIRE |
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