Cardiopulmonary exercise testing improves diagnostic specificity in patients with echocardiography-suspected pulmonary hypertension
Cardiopulmonary exercise testing improves diagnostic specificity in patients with echocardiography-suspected pulmonary hypertension
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DOI：
10.1002/clc.22635
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发表时间：
2017-02-01
影响因子：
2.7
通讯作者：
Liu, Jin-Ming
中科院分区：
文献类型：
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作者：
Zhao, Qin-Hua;Wang, Lan;Liu, Jin-Ming
多谱勒超声心动图通常是可疑肺动脉高压(PH)患者的首选诊断方法，但单独使用往往不准确，尤其是在轻度PH患者。假设对于超声心动图疑似PH患者，运动心肺试验(CPET)可作为提高诊断准确性的辅助工具。随后对所有受试者进行CPET评估，并通过右心导管法确定PH。我们分析了患者的CPET数据，并得出了CPET预测规则来区分PH。结果纳入88例患者(27例确诊为PH，61例排除PH)。与非PH组比较，PH组的最大摄氧量(VO2)、有氧能力(AT)、呼气末二氧化碳分压(PETCO2)、吸氧效率平台(OUEP)和吸氧效率斜率(OUES)较低，每分钟通气量(VE)/二氧化碳排出量(VCO2)斜率和最低VE/VCO2斜率较高(P<0.001)。校正了年龄和体重指数的多因素Logistic回归分析表明，VE/VCO2斜率和AT是PH的独立预测因子。VE/VCO2斜率与AT的比值在0.98的曲线值下达到高值区。0.5分诊断PH的特异度为95%，灵敏度为92.6%。结论结合VE/VCO2斜率和AT的评分对超声心动图可疑的PH患者筛查PH有较高的特异度。
BackgroundDoppler echocardiography is usually the first diagnostic investigation for patients suspected with pulmonary hypertension (PH), but it is often inaccurate when used alone, especially in mild PH.HypothesisCardiopulmonary exercise testing (CPET) may serve as a complementary tool to improve diagnostic accuracy in echocardiography-suspected PH possible patients.MethodsEighty-eight consecutive patients with suspected PH (referred to as PH possible hereafter) based on echocardiography were included in the study. CPET was assessed subsequently and PH was confirmed by right-heart catheterization in all subjects. We analyzed CPET data from patients and derived a CPET prediction rule to hemodynamically differentiate PH.ResultsEighty-eight patients (27 patients with confirmed PH, and PH ruled out in 61 patients) were included in the study. Compared with non-PH patients, the PH subjects had lower peak oxygen uptake (VO2 ), aerobic capacity (AT), peak partial pressure of end-tidal CO2 (PETCO2 ), oxygen uptake efficiency plateau (OUEP), and oxygen uptake efficiency slope (OUES), along with higher minute ventilation (VE)/carbon dioxide output (VCO2 ) slope and lowest VE/VCO2 (P < 0.001). VE/VCO2 slope and AT were independent predictors of PH derived from multivariate logistic regression adjusted for age and body mass index. A score combining VE/VCO2 slope and AT reached a high area under the curve value of 0.98. A score 0.5 had 95% specificity and 92.6% sensitivity for diagnosis of PH.ConclusionsA score combining VE/VCO2 slope and AT provides high specificity in screening out PH from a pool of echocardiography-suspected PH patients.