PURPOSE: In the early stages of Pulmonary Arterial Hypertension (PAH), the pulmonary arterial pressure may be normal at rest, but elevated during exercise. Exercise-Stress-Echocardiography (EE) may detect these abnormal reactions.
METHODS: We examined patients with a risk factor for PAH with EE and Cardiopulmonary Exercise Testing (CPET), and we determined the systolic PAP at rest (rSPAP) and during exercise (exSPAP). Right Heart Catheterisation (RHC) and the measurement of the mean PAP (mPAP) was recommended for patients with an abnormal EE result (exSPAP>40mmHg) and for patients with a VO2 peak<75% predicted. The results of the EE and RHC examinations were compared. Patients with known PAH were excluded.
RESULTS: 60 patients with Systemic Sclerosis, Systemic Lupus Erythematodes and liver cirrhosis were examined. rSPAP was elevated in 1 patient (54mmHg) (RHC mPAP: 27mmHg). 27 patients had normal rSPAP (27±5mmHg), and abnormal exSPAP (54±9mmHg). 18 of these patients were examined by RHC. 1 patient had PAH at rest (mPAP: 27mmHg), 10 had an exercise-induced PAH (mPAP at rest: 17±3mmHg, ex mPAP: 36±4mmHg). 6 patients had an exercise induced PH with pulmonary capillary wedge pressure (PAWP) elevation (PAWP at rest: 7±2mmHg, ex PAWP: 32±10mmHg), and 1 patient had normal SPAP at rest and during exercise. EE showed normal values in 32 patients at rest and during exercise (rSPAP: 23±3mmHg, exSPAP: 29±7mmHg). Out of these, 6 patients underwent RHC because of limited exercise capacity. 4 of them had an exercise-induced PAH (mPAP at rest: 18±4mmHg, ex mPAP: 39±7mmHg), 2 of them had normal values.
CONCLUSION: In patients with a risk factor for PAH, EE showed an abnormal reaction in 47%. At the given indication, the positive predictive value of EE for exercise-induced PAH is 95%, the negative predictive value 33%.
CLINICAL IMPLICATIONS: EE combined with CPET might be a suitable method to diagnose PAH in the very early stage of the disease.
DISCLOSURE: Gabor Kovacs, No Financial Disclosure Information; No Product/Research Disclosure Information