ACCS 2016 Chicago

  • Aanvrager: Mevrouw A.C.J.M. van Riel

American College of Cardiology Scientific Sessions 2016 Chicago USA van 2- 4 april 2016 Annelieke C.M.J. van Riel AMC, afd. Cardiologie

Title: Accuracy of Echocardiographic Measures of the Exercise-Induced Change in Pulmonary Artery Pressures: Importance of Tricuspid Regurgitation Doppler Quality

Author block: Annelieke CMJ van Riel (1,2), Alexander R Opotowsky (3,4), Mario Santos (5), Jose M Rivero (4), Andy Dhimitri (4), Michael J Landzberg (3,4), Barbara JM Mulder (1,2), Berto J Bouma (1), Aaron B Waxman (6), David M Systrom (6), Amil M Shah (4)

Affiliations: (1) Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; (2) ICIN – Netherlands Heart Institute, Utrecht, The Netherlands; (3) Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; (4) Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; (5) Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal; (6) Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA

Background :
While exercise echocardiography is often used as a noninvasive screening strategy to diagnose pulmonary hypertension, it is technically challenging and limited data exist regarding the accuracy of echo estimates during exercise.

Methods:
Among 62 patients with unexplained exertional intolerance undergoing upright invasive cardiopulmonary exercise testing with concomitant echo, we compared tricuspid regurgitation (TR) Doppler based estimates of pulmonary artery systolic pressure (PASP) with invasively obtained pulmonary artery pressures at rest and peak exercise. TR Doppler quality was graded as: (A) well-defined envelope or (B) poor signal-to-noise ratio with suboptimal signal border.

Results:
Mean age was 62±13 years and 31% were male. Good quality TR Doppler (grade A) was present in 81% at rest, 45% at peak exercise, and 42% for both. For grade A, good correlation was found between non-invasive and invasive measures of PASP at rest (r=0.82 ,p<0.001; bias 1.8±6.5 mmHg), peak exercise (r=0.94, p<0.001; bias -2.2±6.0), and for PASP change during exercise (r=0.83, p<0.001; bias 0.8±7.8). In contrast, correlations were poor for grade B TR Doppler quality at rest (r=0.34, p=0.29; bias 0.5±22.0), peak exercise (r=0.39, p=0.03; bias 6.3±21.6), and for change between rest and peak (r=0.35, p=0.05; bias 6.5±13.5).

Conclusion:
The correlation between echocardiographic and invasive estimation of PASP during upright exercise is good, but highly dependent on TR Doppler quality.

Keywords:
exercise echocardiography, cardiopulmonary exercise test, tricuspid regurgitation