Reduced pulmonary vascular reserve during stress echocardiography in confirmed pulmonary hypertension and patients at ri
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ORIGINAL PAPER
Reduced pulmonary vascular reserve during stress echocardiography in confirmed pulmonary hypertension and patients at risk of overt pulmonary hypertension Karina Wierzbowska‑Drabik1 · Jarosław D. Kasprzak1 · Michele D′Alto2 · Gergely Ágoston3 · Albert Varga3 · Francesco Ferrara4 · Miguel Amor5 · Quirino Ciampi6 · Eduardo Bossone7 · Eugenio Picano8 Received: 10 April 2020 / Accepted: 21 May 2020 © The Author(s) 2020
Abstract Noninvasive estimation of systolic pulmonary artery pressure (SPAP) during exercise stress echocardiography (ESE) is recommended for pulmonary hemodynamics evaluation but remains flow-dependent. Our aim was to assess the feasibility of pulmonary vascular reserve index (PVRI) estimation during ESE combining SPAP with cardiac output (CO) or exercise-time and compare its value in three group of patients: with invasively confirmed pulmonary hypertension (PH), at risk of PH development (PH risk) mainly with systemic sclerosis and in controls (C) without clinical risk factors for PH, age-matched with PH risk patients. We performed semisupine ESE in 171 subjects: 31 PH, 61 PH at risk and 50 controls as well as in 29 young, healthy normals. Rest and stress assessment included: tricuspid regurgitant flow velocity (TRV), pulmonary acceleration time (ACT), CO (Doppler-estimated). SPAP was calculated from TRV or ACT when TRV was not available. We estimated PVRI based on CO (peak CO/SPAP*0.1) or exercise-time (ESE time/SPAP*0.1). During stress, TRV was measurable in 44% patients ACT in 77%, either one in 95%. PVRI was feasible in 65% subjects with CO and 95% with exercise-time (p 110 ms, the abnormal
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