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- Title
Cardiopulmonary Exercise Testing to Detect Chronic Thromboembolic Pulmonary Hypertension in Patients with Normal Echocardiography.
- Authors
Held, Matthias; Grün, Maria; Holl, Regina; Hübner, Gudrun; Kaiser, Ralf; Karl, Sabine; Kolb, Martin; Schäfers, Hans Joachim; Wilkens, Heinrike; Jany, Berthold
- Abstract
Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious complication of pulmonary embolism (PE). Taking into account the reported incidence of CTEPH after acute PE, the number of patients with undiagnosed CTEPH may be high. Objectives: We aimed to determine if cardiopulmonary exercise testing (CPET) could serve as complementary tool in the diagnosis of CTEPH and can detect CTEPH in patients with normal echocardiography. Methods: At diagnosis, we analyzed the data of CPET parameters in 42 patients with proven CTEPH and 51 controls, and evaluated the performance of two scores. Results: VE/VCO2 slope, EQO2, EQCO2, P(A-a)O2, end-tidal partial pressure of CO2 at anaerobic threshold (PETCO2) and capillary to end-tidal carbon dioxide gradient [P(c-ET)CO2] were significantly different between patients with CTEPH and controls (p < 0.001). P(c-ET)CO2 was the single parameter with the highest sensitivity (85.7%) and specificity (88.2%). A score combining VE/VCO2 slope, P(A-a)O2, P(c-ET)CO2, PETCO2 [4-parameter-CPET (4-P-CPET) score] reached a sensitivity of 83.3% and a specificity of 92.2% after cross-validation. In 42 patients with CTEPH, echocardiography identified PH in 29 patients (69%), but it was normal in 13 patients (31%). All patients with normal or unmeasurable right ventricular systolic pressure had a pathological CPET. Twelve of the 13 patients (92%) were detected by both CPET scores. Conclusion: CPET is a useful noninvasive diagnostic tool for the detection of CTEPH in patients with suspected PH but normal echocardiography. The 4-P-CPET score provides a high sensitivity with the highest specificity. © 2014 S. Karger AG, Basel
- Subjects
EXERCISE tests; BLOOD pressure; CARDIOPULMONARY system; ECHOCARDIOGRAPHY; PULMONARY artery; PULMONARY embolism; PULMONARY hypertension; RESEARCH funding; T-test (Statistics); THROMBOEMBOLISM; RETROSPECTIVE studies; RECEIVER operating characteristic curves
- Publication
Respiration, 2014, Vol 87, Issue 5, p379
- ISSN
0025-7931
- Publication type
Article
- DOI
10.1159/000358565