Chest
Original ResearchEchocardiographyAssessment of Pulmonary Arterial Pressure During Exercise in Collagen Vascular Disease: Echocardiography vs Right-Sided Heart Catheterization
Section snippets
Materials and Methods
Patients with connective tissue disease were referred to our center for inclusion in this study. They were all diagnosed by an expert panel, including rheumatologists, dermatologists, angiologists, cardiologists, and pulmonologists, according to American College of Rheumatology criteria.27, 28, 29 Exclusion criteria were a history of PAH or a known SPAP > 40 mm Hg at rest based on previous echocardiography, severe lung or bronchial disease (FEV1 <65% predicted), systolic or diastolic left
Results
Ninety-one patients with connective tissue disease were screened for inclusion and exclusion criteria, and 55 patients were ultimately enrolled in the study. The other 36 patients were not enrolled because of significant lung (n = 7) or cardiac (n = 8) disease, preexisting pulmonary hypertension (n = 9), or refusal to participate (n = 12). Three further patients with systemic sclerosis (two with limited and one with diffuse cutaneous systemic sclerosis) were excluded after EDE because of
Discussion
We examined patients with a well-defined, long-standing diagnosis of connective tissue disease without relevant pulmonary fibrosis or known PAH. We applied a combination of CPET with EDE to screen for PAH. A considerable number of these patients underwent RHC at rest and exercise. In accordance with previous studies performing hemodynamic measurements during exercise,32, 33, 34, 35, 36 pressure values were averaged over several respiratory cycles. Also, during stress echocardiography no breath
Conclusions
EDE appears to be a useful, noninvasive method to assess SPAP at rest and during graded exercise in connective tissue disease. The combination of EDE with CPET increases the sensitivity to detect exercise SPAP > 40 mm Hg, but RHC remains the gold standard for assessment of PAH.
Acknowledgments
Author contributions: Dr. Kovacs: initiated and performed the study and interpreted the results.
Dr Maier: performed the Doppler echocardiography examinations in all patients.
Dr Aberer: provided patients for the study after careful examination and worked on the manuscript.
Dr Brodmann: provided patients for the study after careful examination and worked on the manuscript.
Dr Scheidl: provided patients for the study after careful examination and worked on the manuscript.
Dr Hesse: provided patients
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Funding/support: This study was sponsored by an unrestricted grant from Actelion Austria and Aktion Österreich-Ungarn, an international nonprofit organization.
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