Karys Khilzi, Lucilla Piccari, Gerard Franco, Anna Rodó-Pin, Anna Herranz, Isabel Blanco, Giuseppe Paciocco, Lorenzo Volpiano, Jose Gonzalez Garcia, Ana Diez-Llaneza, Lluis Molina, Diego A Rodríguez Chiaradía
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This retrospective study investigated patients with residual thromboembolic disease on V/Q scintigraphy with persistent symptoms despite adequate anticoagulation after 3 months of acute PE, and resting echocardiography with a low probability of PH. At rest and during exercise, CPET and doppler echocardiography were performed following a standard protocol. Forty-five patients were included, completing a follow-up period of at least 24 months. The mean (standard deviation) age was 63 (15) years, and 24 (53%) patients were male. Four patients developed CTEPH after 2 years follow up. Correlation analyses showed that the peak TAPSE was significantly associated with peak workload (<i>r</i> = 0.454, <i>p</i> = 0.003), peak VO<sub>2</sub> (<i>r</i> = 0.558, <i>p</i> < 0.001), VE/VECO<sub>2</sub> (AT) (<i>r</i> = -0.531, <i>p</i> < 0.001), and oxygen pulse (<i>r</i> = 0.375, <i>p</i> = 0.02). TAPSE/PASP was only slightly associated with peak workload (<i>r</i> = 0.300, <i>p</i> = 0.045). By contrast, the change on TAPSE (from rest to peak) was significantly correlate with peak oxygen uptake (<i>r</i> = 0.491, <i>p</i> = 0.01). Also, reduced VO<sub>2</sub> at AT and TAPSE/PASP was seen in patients with CTEPH. CPET with synchronic echocardiography could be a useful tool in early assessment of symptomatic patients with perfusion defects on imaging after 3 months of correctly treated PE.</p>","PeriodicalId":20927,"journal":{"name":"Pulmonary Circulation","volume":"15 1","pages":"e70045"},"PeriodicalIF":2.2000,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798863/pdf/","citationCount":"0","resultStr":"{\"title\":\"Cardiopulmonary Exercise Testing With Simultaneous Echocardiography After Pulmonary Embolism.\",\"authors\":\"Karys Khilzi, Lucilla Piccari, Gerard Franco, Anna Rodó-Pin, Anna Herranz, Isabel Blanco, Giuseppe Paciocco, Lorenzo Volpiano, Jose Gonzalez Garcia, Ana Diez-Llaneza, Lluis Molina, Diego A Rodríguez Chiaradía\",\"doi\":\"10.1002/pul2.70045\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Although current guidelines recommend standard cardiopulmonary exercise testing (CPET) to evaluate symptomatic patients after pulmonary embolism (PE), CPET with simultaneous echocardiography could provide relevant information to evaluate right ventricular-pulmonary arterial coupling. 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Correlation analyses showed that the peak TAPSE was significantly associated with peak workload (<i>r</i> = 0.454, <i>p</i> = 0.003), peak VO<sub>2</sub> (<i>r</i> = 0.558, <i>p</i> < 0.001), VE/VECO<sub>2</sub> (AT) (<i>r</i> = -0.531, <i>p</i> < 0.001), and oxygen pulse (<i>r</i> = 0.375, <i>p</i> = 0.02). TAPSE/PASP was only slightly associated with peak workload (<i>r</i> = 0.300, <i>p</i> = 0.045). By contrast, the change on TAPSE (from rest to peak) was significantly correlate with peak oxygen uptake (<i>r</i> = 0.491, <i>p</i> = 0.01). Also, reduced VO<sub>2</sub> at AT and TAPSE/PASP was seen in patients with CTEPH. 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引用次数: 0
摘要
虽然目前的指南推荐标准心肺运动试验(CPET)来评估肺栓塞(PE)后的症状患者,但CPET同时超声心动图可以提供评估右心室-肺动脉耦合的相关信息。本研究的目的是研究运动引起的左室功能或左室-动脉耦合的超声心动图变量在运动后3个月的残余血栓性缺陷患者。这项回顾性研究调查了急性PE 3个月后,尽管有充分的抗凝治疗,但仍有症状的残留血栓栓塞性疾病的V/Q扫描患者,以及静息超声心动图显示低ph的患者。在静息和运动期间,CPET和多普勒超声心动图按照标准方案进行。包括45名患者,完成了至少24个月的随访期。平均(标准差)年龄为63(15)岁,男性24例(53%)。随访2年后,4例患者出现CTEPH。相关分析显示,峰值TAPSE与峰值工作负荷(r = 0.454, p = 0.003)、峰值VO2 (r = 0.558, p 2 (AT)) (r = -0.531, p r = 0.375, p = 0.02)显著相关。TAPSE/PASP与高峰工作负荷仅轻微相关(r = 0.300, p = 0.045)。相比之下,TAPSE的变化(从静止到峰值)与峰值摄氧量显著相关(r = 0.491, p = 0.01)。此外,在CTEPH患者中,at和TAPSE/PASP处的VO2减少。在正确治疗PE 3个月后,CPET与同步超声心动图可作为早期评估有灌注缺陷症状的患者的有用工具。
Cardiopulmonary Exercise Testing With Simultaneous Echocardiography After Pulmonary Embolism.
Although current guidelines recommend standard cardiopulmonary exercise testing (CPET) to evaluate symptomatic patients after pulmonary embolism (PE), CPET with simultaneous echocardiography could provide relevant information to evaluate right ventricular-pulmonary arterial coupling. The aim of this study was to investigate exercise-induced changes in echocardiographic variables of RV function or RV- arterial coupling in patients with residual thrombotic defects at 3 months after PE. This retrospective study investigated patients with residual thromboembolic disease on V/Q scintigraphy with persistent symptoms despite adequate anticoagulation after 3 months of acute PE, and resting echocardiography with a low probability of PH. At rest and during exercise, CPET and doppler echocardiography were performed following a standard protocol. Forty-five patients were included, completing a follow-up period of at least 24 months. The mean (standard deviation) age was 63 (15) years, and 24 (53%) patients were male. Four patients developed CTEPH after 2 years follow up. Correlation analyses showed that the peak TAPSE was significantly associated with peak workload (r = 0.454, p = 0.003), peak VO2 (r = 0.558, p < 0.001), VE/VECO2 (AT) (r = -0.531, p < 0.001), and oxygen pulse (r = 0.375, p = 0.02). TAPSE/PASP was only slightly associated with peak workload (r = 0.300, p = 0.045). By contrast, the change on TAPSE (from rest to peak) was significantly correlate with peak oxygen uptake (r = 0.491, p = 0.01). Also, reduced VO2 at AT and TAPSE/PASP was seen in patients with CTEPH. CPET with synchronic echocardiography could be a useful tool in early assessment of symptomatic patients with perfusion defects on imaging after 3 months of correctly treated PE.
期刊介绍:
Pulmonary Circulation''s main goal is to encourage basic, translational, and clinical research by investigators, physician-scientists, and clinicans, in the hope of increasing survival rates for pulmonary hypertension and other pulmonary vascular diseases worldwide, and developing new therapeutic approaches for the diseases. Freely available online, Pulmonary Circulation allows diverse knowledge of research, techniques, and case studies to reach a wide readership of specialists in order to improve patient care and treatment outcomes.