A comparative study on the diagnostic efficacy of different diagnostic criteria for exercise pulmonary hypertension. (15th June 2023)

• Record Type: Journal Article
• Authors: Guo, Wei; Zhang, Meng; Li, Hui; Wang, Yan; Zhang, Wenmei; Chen, Yong; Duan, Shengchen; Guo, Xueran; Yin, Ao; Peng, Jiafei; An, Chunrong; Xiao, Yao; Wan, Jun
• Is Part Of: International journal of cardiology. Volume 381(2023)
• Page Start: 94
• Page End: 100
• Publication Date: 2023-06-15
• Subjects: Pulmonary hypertension -- Exercise -- Right heart catheterization -- Diagnosis; RHC right heart catheterization -- eRHC exercise right heart catheterization -- PH pulmonary hypertension -- ePH exercise pulmonary hypertension -- nPH non-exercise pulmonary hypertension -- HFpEF heart failure with preserved ejection fraction -- PAP pulmonary artery pressure -- mPAP mean pulmonary artery pressure -- CO cardiac output -- CI cadiac index, confidence interval -- PAWP pulmonary artery wedge pressure -- TPR total pulmonary resistance -- PVR pulmonary vascular resistance -- 6MWD 6-minute walking distance -- WHO-FC WHO functional class -- BNP brain natriuretic peptide -- TRS tricuspid regurgitation severity -- R1 ∼ R6 resistance level 1 - 6; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2023.03.068
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Exercise pulmonary hypertension (ePH) has three common diagnostic criteria: the mean pulmonary artery pressure (mPAP) > 30 mmHg and total pulmonary resistance (TPR) at peak exercise >3 Wood units ("Joint criteria"), the mPAP/cardiac output (CO) slope of the two-point measurement (ΔmPAP/ΔCO) > 3 mmHg/L/min ("Two-point criteria"), and the mPAP/CO slope of the multi-point data >3 mmHg/L/min ("Multi-point criteria"). We compared the diagnostic efficacy of these criteria, which remain controversial. Methods: Following resting right heart catheterization (RHC), all patients underwent exercise RHC (eRHC). The patients were divided into different ePH and non-exercise pulmonary hypertension (nPH) groups according to the above criteria. Joint criteria were used as the reference to compare the other two, namely diagnostic concordance, sensitivity and specificity. We conducted further analysis to determine the correlation between different diagnostic criteria grouping and the clinical severity of PH. Results: Thirty-three patients with mPAPrest ≤ 20 mmHg were enrolled. a) Diagnostic concordance, sensitivity and specificity: compared with Joint criteria, the diagnostic concordances of Two-point criteria and Multi-point criteria were 78.8% (κ = 0.570, P < 0.01) and 90.9% (κ = 0.818, P < 0.01), respectively; the sensitivity of Two-point criteria was high (100%), but the specificity was poor (56.3%); however, Multi-point criteria exhibited higher sensitivity (94.1%) and specificity (87.5%). b) Clinically relevant analysis: a significant difference was observed in several clinical severity indicators between ePH and nPH patients according to Multi-point criteria grouping(all P < 0.05). Conclusion: Multi-point criteria are more clinically relevant and provide better diagnostic efficiency. Highlights: Exercise right heart catheterization can be of clinical value in diagnosing exercise pulmonary hypertension. The linearized multi-point mPAP/CO slope criteria have a better diagnostic performance on exercise pulmonary hypertension. The linearized multi-point mPAP/CO slope criteria are of more clinically relevance.