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Original Research: ECHOCARDIOGRAPHY |

Assessment of Pulmonary Arterial Pressure During Exercise in Collagen Vascular Disease: Echocardiography vs Right-Sided Heart Catheterization

Gabor Kovacs, MD; Robert Maier, MD; Elisabeth Aberer, MD; Marianne Brodmann, MD; Stefan Scheidl, MD; Christian Hesse, MD; Natascha Troester, MD; Wolfgang Salmhofer, MD; Rudolf Stauber, MD; Florentine C. Fuerst, MD; Rene Thonhofer, MD; Petra Ofner-Kopeinig, PhD; Ekkehard Gruenig, MD; Horst Olschewski, MD, FCCP
Author and Funding Information

From the Division of Pulmonology (Drs Kovacs, Scheidl, Hesse, Troester, and Olschewski), the Division of Cardiology (Dr Maier), the Division of Dermatology (Drs Aberer and Salmhofer), the Division of Angiology (Dr Brodmann), the Division of Gastroenterology (Dr Stauber), the Division of Rheumatology (Dr Fuerst), and the Institute for Medical Informatics, Statistics, and Documentation (Dr Ofner-Kopeinig), Medical University of Graz, Graz, Austria; the Department of Internal Medicine (Dr Thonhofer), State Hospital Mürzzuschlag, Mürzzuschlag, Austria; and the Department of Cardiology (Dr Gruenig), University of Heidelberg, Heidelberg, Germany.

Correspondence to: Gabor Kovacs, MD, Medical University of Graz, Division of Pulmonology, 8036 Graz, Auenbruggerplatz 20, Austria; e-mail: gabor.kovacs@klinikum-graz.at


Funding/support: This study was sponsored by an unrestricted grant from Actelion Austria and Aktion Österreich-Ungarn, an international nonprofit organization.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(2):270-278. doi:10.1378/chest.09-2099
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Background:  This study compared the results of exercise Doppler echocardiography (EDE) with right-sided heart catheterization (RHC) and evaluated the combination of EDE and cardiopulmonary exercise testing (CPET) as a screening method for early pulmonary vasculopathy in patients with connective tissue disease.

Methods:  Patients (N = 52) with connective tissue disease (predominantly systemic sclerosis) and without known pulmonary arterial hypertension underwent both EDE and CPET. If systolic pulmonary arterial pressure (SPAP) was > 40 mm Hg during exercise or peak oxygen uptake (V˙ o2) was < 75% predicted, RHC was suggested.

Results:  EDE showed an SPAP > 40 mm Hg during exercise in 26/52 patients. Additionally, CPET showed a peak V˙ o2 < 75% predicted in 10/26 patients with SPAP ≤ 40 mm Hg upon exercise. Accordingly, RHC was suggested to 36 patients. RHC was performed in 28 of these patients, revealing SPAP > 40 mm Hg in 25 patients (n = 1 at rest, n = 24 during exercise). SPAP values assessed by EDE showed no significant difference vs RHC at rest, 25 W, 50 W, and maximal exercise (difference [95% CI]: 0.3 [−2.7; 3.2], −1.3 [−7.1; 4.4], 0.9 [−7.7; 5.9], and −5.6 [−13.5; 2.2] mm Hg). Eight patients with exercise SPAP > 40 mm Hg had an exercise pulmonary arterial wedge pressure > 20 mm Hg, suggesting exercise-induced left ventricular diastolic dysfunction not detectable by EDE.

Conclusions:  EDE appears to be a reasonable noninvasive method to detect SPAP increase during exercise in connective tissue disease. In combination with CPET, it may be a useful screening tool for early pulmonary vasculopathy, although RHC remains the gold standard for hemodynamic assessment.

Trial registration:  clinicaltrials.gov; Identifier: NCT00609349 (Early Recognition of Pulmonary Arterial Hypertension)

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