Evaluation of end-tidal CO2 pressure at the anaerobic threshold for detecting and assessing pulmonary hypertension
Evaluation of end-tidal CO2 pressure at the anaerobic threshold for detecting and assessing pulmonary hypertension
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DOI：
10.1007/s00380-017-0999-y
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发表时间：
2017-11-01
影响因子：
1.5
通讯作者：
Kihara, Yasuki
中科院分区：
文献类型：
--
作者：
Higashi, Akifumi;Dohi, Yoshihiro;Kihara, Yasuki
心肺运动试验 (CPET) 可用于评估疑似或确诊的肺动脉高压 (PH) 患者。运动期间呼气末二氧化碳压力 (PETCO2) 会随着肺动脉压力升高而降低。然而，通气参数（例如 CPET）用于检测 PH 的效用仍不清楚。我们对 155 名接受右心导管插入术和 CPET 的患者进行了回顾。 59 名患者患有 PH [平均肺动脉压 (mPAP) ae25 mmHg]。无氧阈 (AT) 处的 PETCO2 与 mPAP 之间存在负相关（r = -0.66；P < 0.01）。多元回归分析表明，AT 处的 PETCO2 与 mPAP 升高独立相关（P = 0.04）。当 AT PETCO2 的受试者工作特征曲线分析确定的截止值为 ae34.7 mmHg 时，CPET 对 PH 的敏感性和特异性分别为 80% 和 86%。超声心动图和 CPET 的结合提高了检测 PH 的敏感性，而没有显着降低特异性（敏感性 87%，特异性 85%）。 AT 处 PETCO2 的评估对于估计肺压很有用。 CPET 与之前的 PH 筛查算法相结合可能会增强 PH 的诊断能力。
Cardiopulmonary exercise testing (CPET) is useful for the evaluation of patients with suspected or confirmed pulmonary hypertension (PH). End-tidal carbon dioxide pressure (PETCO2) during exercise is reduced with elevated pulmonary artery pressure. However, the utility of ventilatory parameters such as CPET for detecting PH remains unclear. We conducted a review in 155 patients who underwent right heart catheterization and CPET. Fifty-nine patients had PH [mean pulmonary arterial pressure (mPAP) ae25 mmHg]. There was an inverse correlation between PETCO2 at the anaerobic threshold (AT) and mPAP (r = -0.66; P < 0.01). Multiple regression analysis showed that PETCO2 at the AT was independently associated with an elevated mPAP (P = 0.04). The sensitivity and specificity of CPET for PH were 80 and 86%, respectively, when the cut-off value identified by receiver operating characteristic curve analysis for PETCO2 at the AT was ae34.7 mmHg. A combination of echocardiography and CPET improved the sensitivity in detecting PH without markedly reducing specificity (sensitivity 87%, specificity 85%). Evaluation of PETCO2 at the AT is useful for estimating pulmonary pressure. A combination of CPET and previous screening algorithms for PH may enhance the diagnostic ability of PH.