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dc.contributor.authorClaessen, Guido-
dc.contributor.authorLa Gerche, Andre-
dc.contributor.authorVoigt, Jens-Uwe-
dc.contributor.authorDymarkowski, Steven-
dc.contributor.authorSchnell, Frederic-
dc.contributor.authorPetit, Thibault-
dc.contributor.authorWillems, Rik-
dc.contributor.authorClaus, Piet-
dc.contributor.authorDelcroix, Marion-
dc.contributor.authorHEIDBUCHEL, Hein-
dc.identifier.citationJACC-CARDIOVASCULAR IMAGING, 9 (5), p. 532-543-
dc.description.abstractOBJECTIVES The authors have compared exercise echocardiography and exercise cardiac magnetic resonance imaging with simultaneous invasive pressure registration (ExCMR(ip)) for the assessment of pulmonary vascular and right ventricular (RV) function. BACKGROUND Exercise echocardiography may enable early diagnosis of pulmonary vascular disease, but its accuracy is untested. METHODS Exercise imaging was performed in 61 subjects (19 athletes, 9 healthy nonathletes, 8 healthy BMPR2 [bone morphogenetic protein receptor type II] mutation carriers, 5 patients with new or worsening dyspnea after acute pulmonary embolism, and 20 patients with chronic thromboembolic pulmonary hypertension). Echocardiographic variables included mean pulmonary artery pressure (mPAP) and systolic pulmonary artery pressure (sPAP), cardiac output (CO), RV fractional area change, tricuspid annular systolic excursion, and RV end-systolic pressure-area ratio as a surrogate measure of RV contractile reserve. ExCMR(ip) provided measurements of CO, RV ejection fraction, mPAP, sPAP, and RV end-systolic pressure-volume ratio at rest and during exercise. Abnormal pulmonary vascular reserve was defined as mPAP/CO slope >3 mm Hg/l/min by ExCMR(ip). RESULTS Echocardiographic determination of mPAP/CO was possible in 53 of 61 subjects (87%). mPAP/CO by echocardiography was higher than that obtained by ExCMR(ip) (+0.9 mm Hg/l/min; 95% limits of agreement, -3.6 to 5.4), but enabled accurate identification of patients with abnormal pulmonary vascular reserve (area under the receiver-operating characteristic curve, 0.88 [95% confidence interval (CI): 0.77 to 1.00; p < 0.0001]). Simplified relationships between sPAP and exercise intensity had similar accuracy in identifying subjects with pulmonary vascular disease (area under the receiver-operating characteristic curve, 0.95 [95% CI: 0.88 to 1.01]; p < 0.0001). RV fractional area change by echocardiography correlated strongly with RV ejection fraction by ExCMR(ip), whereas a moderate correlation was found between tricuspid annular systolic excursion and RV ejection fraction. A moderate correlation was found between ratios of peak exercise to resting RV end-systolic pressure-area ratio and RV end-systolic pressurevolume ratio (r = 0.64; p < 0.0001). CONCLUSIONS Echocardiographic estimates of RV and pulmonary vascular function are feasible during exercise and identify pathology with reasonable accuracy. They represent valid screening tools for the identification of pulmonary vascular disease in routine clinical practice. (C) 2016 by the American College of Cardiology Foundation.-
dc.description.sponsorshipThis study was funded by a grant from the Fund for Scientific Research Flanders (FWO), Belgium. Dr. Willems is supported as a clinical researcher by the Fund for Scientific Research Flanders (FWO); receives research funding from Biotronik, Boston Scientific Belgium, and Medtronic Belgium; and has received speaker and consultancy fees from and participated in clinical trials by different manufactures of cardiac implantable electronic devices (Medtronic, Boston Scientific, Biotronik, St. Jude Medical, and Sorin). Dr. La Gerche is funded by a Career Development Fellowship from the National Health and Medical Research Council and National Heart Foundation of Australia (NHMRC and NHF). Dr. Schnell is funded by a grant from the French Federation of Cardiology. Dr. Heidbuchel is on the Speakers Bureau and Advisory Board of Bayer, Boehringer- Ingelheim, Da, Bristol-Myers Squibb, Pfizer, Merck, Biotronik, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The first 2 authors contributed equally to this work.-
dc.subject.othercardiac magnetic resonance imaging; echocardiography; exercise; pulmonary artery pressure; pulmonary hypertension; right ventricular function-
dc.subject.othercardiac magnetic resonance imaging; echocardiography; exercise; pulmonary artery pressure; pulmonary hypertension; right ventricular function-
dc.titleAccuracy of Echocardiography to Evaluate Pulmonary Vascular and RV Function During Exercise-
dc.typeJournal Contribution-
dc.description.notes[Claessen, Guido; La Gerche, Andre; Voigt, Jens-Uwe; Schnell, Frederic; Petit, Thibault; Willems, Rik; Claus, Piet] Katholieke Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium. [Claessen, Guido; Voigt, Jens-Uwe; Dymarkowski, Steven; Petit, Thibault; Willems, Rik; Delcroix, Marion] Univ Hosp Leuven, Herestr 49, B-3000 Leuven, Belgium. [La Gerche, Andre] Baker IDI Heart & Diabet Inst, Melbourne, Vic, Australia. [Dymarkowski, Steven] Katholieke Univ Leuven, Dept Imaging & Pathol, Leuven, Belgium. [Schnell, Frederic] Rennes Univ, Dept Physiol, Rennes, France. [Delcroix, Marion] Katholieke Univ Leuven, Dept Clin & Expt Med, Leuven, Belgium. [Heidbuchel, Hein] Univ Hasselt, Hasselt, Belgium. [Heidbuchel, Hein] Jessa Hosp, Ctr Heart, Hasselt, Belgium.-
local.publisher.placeNEW YORK-
item.fulltextWith Fulltext-
item.accessRightsRestricted Access-
item.contributorVoigt, Jens-Uwe-
item.contributorLa Gerche, Andre-
item.contributorPetit, Thibault-
item.contributorClaus, Piet-
item.contributorClaessen, Guido-
item.contributorSchnell, Frederic-
item.contributorDymarkowski, Steven-
item.contributorWillems, Rik-
item.contributorDelcroix, Marion-
item.contributorHEIDBUCHEL, Hein-
item.fullcitationClaessen, Guido; La Gerche, Andre; Voigt, Jens-Uwe; Dymarkowski, Steven; Schnell, Frederic; Petit, Thibault; Willems, Rik; Claus, Piet; Delcroix, Marion & HEIDBUCHEL, Hein (2016) Accuracy of Echocardiography to Evaluate Pulmonary Vascular and RV Function During Exercise. In: JACC-CARDIOVASCULAR IMAGING, 9 (5), p. 532-543.-
item.validationecoom 2017-
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