Introduction Identification of elevated pulmonary artery pressures during exercise has important diagnostic, prognostic and therapeutic implications. Stress echocardiography is frequently used to estimate pulmonary artery pressures during exercise testing, but data supporting this practice are limited. This study examined the accuracy of Doppler echocardiography for the estimation of pulmonary artery pressures at rest and during exercise. Methods Simultaneous cardiac catheterisation-echocardiographic studies were performed at rest and during exercise in 97 subjects with dyspnoea. Echocardiography-estimated pulmonary artery systolic pressure (ePASP) was calculated from the right ventricular (RV) to right atrial (RA) pressure gradient and estimated RA pressure (eRAP), and then compared with directly measured PASP and RAP. Results Estimated PASP was obtainable in 57% of subjects at rest, but feasibility decreased to 15–16% during exercise, due mainly to an inability to obtain eRAP during stress. Estimated PASP correlated well with direct PASP at rest (r=0.76, p<0.0001; bias −1 mmHg) and during exercise (r=0.76, p=0.001; bias +3 mmHg). When assuming eRAP of 10 mmHg, ePASP correlated with direct PASP (r=0.70, p<0.0001), but substantially underestimated true values (bias +9 mmHg), with the greatest underestimation among patients with severe exercise-induced pulmonary hypertension (EIPH). Estimation of eRAP during exercise from resting eRAP improved discrimination of patients with or without EIPH (area under the curve 0.81), with minimal bias (5 mmHg), but wide limits of agreement (−14–25 mmHg). Conclusions The RV–RA pressure gradient can be estimated with reasonable accuracy during exercise when measurable. However, RA hypertension frequently develops in patients with EIPH, and the inability to noninvasively account for this leads to substantial underestimation of exercise pulmonary artery pressures. This study shows that the right atrial component of the estimated pulmonary artery pressure equation is often overlooked, but quite important, and failure to account for this leads to substantial underestimation of the severity of exercise-induced PH http://bit.ly/32xgKTD

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运动时肺动脉压力的无创评估：右心房高压的重要性

介绍 运动期间肺动脉压力升高的识别具有重要的诊断、预后和治疗意义。负荷超声心动图经常用于在运动测试期间估计肺动脉压力，但支持这种做法的数据有限。这项研究检查了多普勒超声心动图在估计静息和运动期间肺动脉压力的准确性。方法 对 97 名呼吸困难受试者在休息和运动期间同时进行心脏导管插入术-超声心动图研究。从右心室 (RV) 到右心房 (RA) 的压力梯度和估计的 RA 压力 (eRAP) 计算超声心动图估计的肺动脉收缩压 (ePASP)，然后与直接测量的 PASP 和 RAP 进行比较。结果 57% 的受试者在休息时可获得估计的 PASP，但在运动期间可行性降低至 15-16%，主要是由于无法在压力期间获得 eRAP。估计的 PASP 与静息时（r=0.76，p<0.0001；偏差 -1 mmHg）和运动期间（r=0.76，p=0.001；偏差 +3 mmHg）的直接 PASP 相关性良好。当假设 eRAP 为 10 mmHg 时，ePASP 与直接 PASP 相关（r=0.70，p<0.0001），但大大低估了真实值（偏差 +9 mmHg），严重运动性肺动脉高压 (EIPH) 患者的低估程度最大. 从静息 eRAP 估计运动期间的 eRAP 提高了对有或没有 EIPH 患者的区分（曲线下面积 0.81），偏差最小（5 mmHg），但一致性范围很广（-14-25 mmHg）。结论 RV-RA 压力梯度在可测量的情况下可以在运动期间以合理的准确度进行估算。然而，RA 高血压经常发生在 EIPH 患者中，无法无创地解释这一点会导致对运动肺动脉压的严重低估。这项研究表明，估计的肺动脉压力方程的右心房分量经常被忽视，但非常重要，未能考虑到这一点会导致对运动诱发 PH 的严重程度的严重低估 http://bit.ly/32xgKTD