Cardiopulmonary Exercise Testing to Detect Chronic Thromboembolic Pulmonary Hypertension in Patients with Normal Echocardiography
Cardiopulmonary Exercise Testing to Detect Chronic Thromboembolic Pulmonary Hypertension in Patients with Normal Echocardiography
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DOI：
10.1159/000358565
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发表时间：
2014-01-01
期刊：
影响因子：
3.7
通讯作者：
Jany, Berthold
中科院分区：
文献类型：
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作者：
Held, Matthias;Gruen, Maria;Jany, Berthold
背景：慢性血栓栓塞性肺动脉高压（CTEPH）是肺栓塞（PE）的严重并发症。考虑到报告的急性PE后CTEPH的发生率，未诊断CTEPH的患者数量可能很高。目的：我们的目的是确定心肺运动试验（CPET）是否可以作为诊断CTEPH的补充工具，并可以检测超声心动图正常患者的CTEPH。研究方法：在诊断时，我们分析了42例CTEPH患者和51例对照组的CPET参数数据，并评估了两种评分的性能。结果如下：CTEPH患者与对照组之间的VE/VCO 2斜率、EQO（2）、EQCO（2）、P（A-a）O-2、无氧阈时潮气末CO2分压（PETCO 2）和毛细血管至潮气末CO2梯度[P（c-ET）CO2]存在显著差异（p < 0.001）。P（c-ET）CO2是敏感性和特异性最高的单项指标，分别为85.7%和88.2%。交叉验证后，联合VE/VCO 2斜率、P（A-a）O-2、P（c-ET）CO2、PET CO2 [4-parameter-CPET（4-P-CPET）score]的评分的敏感性为83.3%，特异性为92.2%。在42例CTEPH患者中，超声心动图发现29例（69%）患者存在PH，但13例（31%）患者正常。所有右心室收缩压正常或不可测量的患者均有病理性CPET。13例患者中有12例（92%）通过两种CPET评分检测到。结论：CPET是一种有用的无创性诊断工具，用于检测可疑PH但超声心动图正常的患者的CTEPH。4-P-CPET评分提供了具有最高特异性的高灵敏度。(C)2014 S. Karger AG，巴塞尔
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, EQO(2), EQCO(2), P(A-a)O-2, 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)O-2, P(c-ET)CO2, PET CO2 [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 un-measurable 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. (C) 2014 S. Karger AG, Basel