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Erschienen in: Heart and Vessels 9/2019

23.03.2019 | Original Article

Predictors of exercise-induced pulmonary hypertension in patients with connective tissue disease

verfasst von: Sunao Miyanaga, Kayoko Kubota, Noriko Iwatani, Kenjuro Higo, Masaaki Miyata, Yoshihisa Horizoe, Satoko Ojima, Shin Kawasoe, Takuro Kubozono, Mitsuru Ohishi

Erschienen in: Heart and Vessels | Ausgabe 9/2019

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Abstract

Screening and early detection of pulmonary arterial hypertension (PAH) in connective tissue disease (CTD) are currently recommended for early treatment. Exercise-induced pulmonary hypertension (EIPH) is thought to be a potential risk of developing resting pulmonary hypertension. However, accurate diagnosis of EIPH is needed hemodynamics by right heart catheterization during exercise. Therefore, we compared various parameters of EIPH group with non-EIPH group in patients with CTD. This study aimed to investigate noninvasive predictors of EIPH. A total of 162 consecutive patients with CTD who received screening of PAH was studied. Thirty-four patients with suspected PAH received right heart catheterization (RHC) at rest. Twenty-four patients without PAH underwent RHC during exercise, and they were divided into the EIPH group (n = 7) and the non-EIPH group (n = 17). Exercise tolerance such as 6-min walk distance and peak VO2/kg in the EIPH group was lower than that in the non-EIPH group. For hemodynamics, pulmonary artery pressure, right atrial pressure, and vascular resistance in the EIPH group were significantly higher than those in the non-EIPH group. In echocardiography, RV Tei index in the EIPH group was significantly higher than that in the non-EIPH group (EIPH vs non-EIPH = 0.42 [0.41, 0.47] vs 0.25 [0.20, 0.32], P = 0.007). The receiver operating characteristics curve showed a cutoff value of RV Tei index (0.41) with a sensitivity of 0.857 and specificity of 0.882. In conclusion, RV Tei index might be a feasible predictor of EIPH in patients with CTD.
Literatur
1.
Zurück zum Zitat Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, Langleben D, Manes A, Satoh T, Torres F, Wilkins MR, Badesch DB (2013) Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol 62:D42–D50CrossRefPubMed Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, Langleben D, Manes A, Satoh T, Torres F, Wilkins MR, Badesch DB (2013) Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol 62:D42–D50CrossRefPubMed
2.
Zurück zum Zitat Ogawa A, Satoh T, Tamura Y, Fukuda K, Matsubara H (2017) Survival of Japanese patients with idiopathic/heritable pulmonary artery hypertension. Am J Cardiol 119(9):1479–1484CrossRefPubMed Ogawa A, Satoh T, Tamura Y, Fukuda K, Matsubara H (2017) Survival of Japanese patients with idiopathic/heritable pulmonary artery hypertension. Am J Cardiol 119(9):1479–1484CrossRefPubMed
3.
Zurück zum Zitat Condliffe R, Kiely DG, Peacock AJ, Corris PA, Gibbs JSR, Vrapi F, Das C, Elliot CA, Johnson M, DeSoyza J, Torpy C, Goldsmith K, Hodgkins D, Hughes RJ, Pepke-Zaba J, Coghlan JG (2009) Connective tissue disease-associated pulmonary arterial hypertension in the modern treatment era. Am J Respir Crit Care Med 179:151–157CrossRefPubMed Condliffe R, Kiely DG, Peacock AJ, Corris PA, Gibbs JSR, Vrapi F, Das C, Elliot CA, Johnson M, DeSoyza J, Torpy C, Goldsmith K, Hodgkins D, Hughes RJ, Pepke-Zaba J, Coghlan JG (2009) Connective tissue disease-associated pulmonary arterial hypertension in the modern treatment era. Am J Respir Crit Care Med 179:151–157CrossRefPubMed
4.
Zurück zum Zitat Humbert M, Yaici A, de Groote P, Montani D, Sitbon O, Launay D, Gressin V, Guillevin L, Clerson P, Simonneau G, Hachulla E (2011) Screening for pulmonary arterial hypertension in patients with systemic sclerosis: clinical characteristics at diagnosis and long-term survival. Arthritis Rheum 63(11):3522–3530CrossRefPubMed Humbert M, Yaici A, de Groote P, Montani D, Sitbon O, Launay D, Gressin V, Guillevin L, Clerson P, Simonneau G, Hachulla E (2011) Screening for pulmonary arterial hypertension in patients with systemic sclerosis: clinical characteristics at diagnosis and long-term survival. Arthritis Rheum 63(11):3522–3530CrossRefPubMed
5.
Zurück zum Zitat Codullo V, Caporali R, Cuomo G, Ghio S, D’Alto M, Fusetti C, Borgogno E, Montecucco C, Valentini G (2013) Stress doppler echocardiography in systemic sclerosis: evidence for a role in the prediction of pulmonary hypertension. Arthritis Rheum 65(9):2403–2411CrossRefPubMed Codullo V, Caporali R, Cuomo G, Ghio S, D’Alto M, Fusetti C, Borgogno E, Montecucco C, Valentini G (2013) Stress doppler echocardiography in systemic sclerosis: evidence for a role in the prediction of pulmonary hypertension. Arthritis Rheum 65(9):2403–2411CrossRefPubMed
6.
Zurück zum Zitat Baptista R, Serra S, Martins R, Teixeira R, Castro G, Salvador MJ, Pereira da Silva JA, Santos L, Monteiro P, Pego M (2016) Exercise echocardiography for the assessment of pulmonary hypertension in systemic sclerosis: a systematic review. Arthritis Res Ther 18(1):153CrossRefPubMedPubMedCentral Baptista R, Serra S, Martins R, Teixeira R, Castro G, Salvador MJ, Pereira da Silva JA, Santos L, Monteiro P, Pego M (2016) Exercise echocardiography for the assessment of pulmonary hypertension in systemic sclerosis: a systematic review. Arthritis Res Ther 18(1):153CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Herve P, Lau EM, Sitbon O, Savale L, Montani D, Godinas L, Lador F, Jais X, Parent F, Gunther S, Humbert M, Simonneau G, Chemla D (2015) Criteria for diagnosis of exercise pulmonary hypertension. Eur Respir J 46(3):728–737CrossRefPubMed Herve P, Lau EM, Sitbon O, Savale L, Montani D, Godinas L, Lador F, Jais X, Parent F, Gunther S, Humbert M, Simonneau G, Chemla D (2015) Criteria for diagnosis of exercise pulmonary hypertension. Eur Respir J 46(3):728–737CrossRefPubMed
8.
Zurück zum Zitat Rich S, Dantzker DR, Ayres SM, Bergofsky EH, Brundage BH, Detre MK, Fishman AP, Goldring RM, Groves BM, Koerner SK, Levy PC, Reid LM, Vreim CE, Williams GW (1987) Primary pulmonary hypertension: a national prospective study. Ann Intern Med 107(2):216–223CrossRefPubMed Rich S, Dantzker DR, Ayres SM, Bergofsky EH, Brundage BH, Detre MK, Fishman AP, Goldring RM, Groves BM, Koerner SK, Levy PC, Reid LM, Vreim CE, Williams GW (1987) Primary pulmonary hypertension: a national prospective study. Ann Intern Med 107(2):216–223CrossRefPubMed
9.
Zurück zum Zitat Kovacs G, Berghold A, Scheidl S, Olschewski H (2009) Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review. Eur Respir J 34(4):888–894CrossRefPubMed Kovacs G, Berghold A, Scheidl S, Olschewski H (2009) Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review. Eur Respir J 34(4):888–894CrossRefPubMed
10.
Zurück zum Zitat Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Noordegraaf AV, Beghetti M, Ghofrani A, Sanchez MAG, Hansmann G, Klepetko W, Lancelloti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M (2015) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European society of cardiology (ESC) and the European respiratory society (ERS): Endorsed by: Association for European paediatric and congenital cardiology (AEPC), international society for heart and lung transplantation (ISHLT). Eur Respir J 46(4):903–975CrossRefPubMed Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Noordegraaf AV, Beghetti M, Ghofrani A, Sanchez MAG, Hansmann G, Klepetko W, Lancelloti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M (2015) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European society of cardiology (ESC) and the European respiratory society (ERS): Endorsed by: Association for European paediatric and congenital cardiology (AEPC), international society for heart and lung transplantation (ISHLT). Eur Respir J 46(4):903–975CrossRefPubMed
11.
Zurück zum Zitat Naeije R, Noordegraaf AV, Kovacs G (2015) Exercise-induced pulmonary hypertension: at last! Eur Respir J 46(3):583–586CrossRefPubMed Naeije R, Noordegraaf AV, Kovacs G (2015) Exercise-induced pulmonary hypertension: at last! Eur Respir J 46(3):583–586CrossRefPubMed
12.
Zurück zum Zitat Lau EMT, Chemla D, Godinas L, Zhu K, Sitbon O, Savale L, Montani D, Jais X, Celermajer DS, Simonneau G, Humbert M, Herve P (2016) Loss of vascular distensibility during exercise is an early hemodynamic marker of pulmonary vascular disease. Chest 149(2):353–361CrossRefPubMed Lau EMT, Chemla D, Godinas L, Zhu K, Sitbon O, Savale L, Montani D, Jais X, Celermajer DS, Simonneau G, Humbert M, Herve P (2016) Loss of vascular distensibility during exercise is an early hemodynamic marker of pulmonary vascular disease. Chest 149(2):353–361CrossRefPubMed
13.
Zurück zum Zitat Bloodworth NC, West JD, Merryman WD (2015) Microvessel mechanobiology in pulmonary arterial hypertension: cause and effect. Hypertension 65(3):483–489CrossRefPubMed Bloodworth NC, West JD, Merryman WD (2015) Microvessel mechanobiology in pulmonary arterial hypertension: cause and effect. Hypertension 65(3):483–489CrossRefPubMed
14.
Zurück zum Zitat Khanna D, Gladue H, Channick R, Chung L, Distler O, Furst DE, Hachulla E, Humbert M, Langleben D, Mathai SC, Saggar R, Visovatti S, Altorok N, Townsend W, FitzGerald J, McLaughlin VV (2013) Recommendations for screening and detection of connective tissue disease-associated pulmonary arterial hypertension. Arthritis Rhem 65(12):3194–3201CrossRef Khanna D, Gladue H, Channick R, Chung L, Distler O, Furst DE, Hachulla E, Humbert M, Langleben D, Mathai SC, Saggar R, Visovatti S, Altorok N, Townsend W, FitzGerald J, McLaughlin VV (2013) Recommendations for screening and detection of connective tissue disease-associated pulmonary arterial hypertension. Arthritis Rhem 65(12):3194–3201CrossRef
15.
Zurück zum Zitat Stamm A, Saxer S, Litchtblau M, Hasler ED, Jordan S, Huber LC, Bloch KE, Distler O, Ulrich S (2016) Exercise pulmonary haemodynamics predict outcome in patients with systemic sclerosis. Eur Respir J 48(6):1658–1667CrossRefPubMed Stamm A, Saxer S, Litchtblau M, Hasler ED, Jordan S, Huber LC, Bloch KE, Distler O, Ulrich S (2016) Exercise pulmonary haemodynamics predict outcome in patients with systemic sclerosis. Eur Respir J 48(6):1658–1667CrossRefPubMed
16.
Zurück zum Zitat Saggar R, Khanna D, Shapiro S, Furst DE, Maranian P, Clements P, Abtin F, Dua S, Belperio J, Saggar R (2012) Effect of ambrisentan treatment on exercise-induced pulmonary hypertension in systemic sclerosis: a prospective single-center, open-label pilot study. Arthritis Rheum 64(12):4072–4077CrossRefPubMed Saggar R, Khanna D, Shapiro S, Furst DE, Maranian P, Clements P, Abtin F, Dua S, Belperio J, Saggar R (2012) Effect of ambrisentan treatment on exercise-induced pulmonary hypertension in systemic sclerosis: a prospective single-center, open-label pilot study. Arthritis Rheum 64(12):4072–4077CrossRefPubMed
17.
Zurück zum Zitat Segreta SA, Lawler L, Opotowsky AR, Systrom D, Waxman AB (2017) Open label study of ambrisentan in patients with exercise pulmonary hypertension. Pulm Circ 7(2):531–538CrossRef Segreta SA, Lawler L, Opotowsky AR, Systrom D, Waxman AB (2017) Open label study of ambrisentan in patients with exercise pulmonary hypertension. Pulm Circ 7(2):531–538CrossRef
18.
Zurück zum Zitat Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adult: a report from the American society of echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23(7):685–713CrossRef Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adult: a report from the American society of echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23(7):685–713CrossRef
19.
Zurück zum Zitat Lewis GD, Bossone E, Naeije R, Grunig E, Saggar R, Lancelloti P, Ghio S, Varga J, Rajagopalan S, Oudiz R, Rubenfire M (2013) Pulmonary vascular hemodynamic response to exercise cardiopulmonary disease. Circulation 128:1470–1479CrossRefPubMed Lewis GD, Bossone E, Naeije R, Grunig E, Saggar R, Lancelloti P, Ghio S, Varga J, Rajagopalan S, Oudiz R, Rubenfire M (2013) Pulmonary vascular hemodynamic response to exercise cardiopulmonary disease. Circulation 128:1470–1479CrossRefPubMed
20.
Zurück zum Zitat Claessen G, Gerche AL, Voigt JU, Dymarkowski S, Schnell F, Petit T, Willems R, Claus P, Delcroix M, Heidbuchel H (2016) Accuracy of echocardiography to evaluate pulmonary vascular and RV function during exercise. JACC Cardiovasc Imaging 9:532–543CrossRefPubMed Claessen G, Gerche AL, Voigt JU, Dymarkowski S, Schnell F, Petit T, Willems R, Claus P, Delcroix M, Heidbuchel H (2016) Accuracy of echocardiography to evaluate pulmonary vascular and RV function during exercise. JACC Cardiovasc Imaging 9:532–543CrossRefPubMed
21.
Zurück zum Zitat van Riel AC, Opotowsky AR, Santos M, Rivero JM, Dhimitri A, Mulder BJ, Bouma BJ, Landzberg MJ, Waxman AB, Systrom DM, Shah AM (2017) Accuracy of echocardiography to estimate pulmonary artery pressures with exercise: a simultaneous invasive-noninvasive comparison. Circ Cardiovasc Imaging 10(4):e005711PubMedPubMedCentral van Riel AC, Opotowsky AR, Santos M, Rivero JM, Dhimitri A, Mulder BJ, Bouma BJ, Landzberg MJ, Waxman AB, Systrom DM, Shah AM (2017) Accuracy of echocardiography to estimate pulmonary artery pressures with exercise: a simultaneous invasive-noninvasive comparison. Circ Cardiovasc Imaging 10(4):e005711PubMedPubMedCentral
22.
Zurück zum Zitat Tei C, Dujardin KS, Hodge DO, Bailey KR, McGoon MD, Tajik AJ, Seward SB (1996) Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 9(6):838–847CrossRef Tei C, Dujardin KS, Hodge DO, Bailey KR, McGoon MD, Tajik AJ, Seward SB (1996) Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 9(6):838–847CrossRef
23.
Zurück zum Zitat Yeo TC, Dujardin KS, Tei C, Mahoney DW, McGoon MD, Seward JB (1998) Value of a doppler-derived index combining systolic and diastolic time intervals in predicting outcome in primary pulmonary hypertension. Am J Cardiol 81(9):1157–1161CrossRefPubMed Yeo TC, Dujardin KS, Tei C, Mahoney DW, McGoon MD, Seward JB (1998) Value of a doppler-derived index combining systolic and diastolic time intervals in predicting outcome in primary pulmonary hypertension. Am J Cardiol 81(9):1157–1161CrossRefPubMed
24.
Zurück zum Zitat Sabbag I, Rudski LG, Therrien J, Hirsch A, Langleben D (2001) Effect of chronic infusion of epoprostenol on echocardiographic right ventricular myocardial performance index and its relation to clinical outcome in patients with primary pulmonary hypertension. Am J Cardiol 88(9):1060–1063CrossRef Sabbag I, Rudski LG, Therrien J, Hirsch A, Langleben D (2001) Effect of chronic infusion of epoprostenol on echocardiographic right ventricular myocardial performance index and its relation to clinical outcome in patients with primary pulmonary hypertension. Am J Cardiol 88(9):1060–1063CrossRef
25.
Zurück zum Zitat Amano H, Abe S, Hirose S, Waku R, Masuyama T, Sakuma M, Toyoda S, Taguchi I, Inoue T, Tei C (2017) Comparison of echocardiographic parameters to assess right ventricular function in pulmonary hypertension. Heart Vessels 32(10):1214–1219CrossRefPubMed Amano H, Abe S, Hirose S, Waku R, Masuyama T, Sakuma M, Toyoda S, Taguchi I, Inoue T, Tei C (2017) Comparison of echocardiographic parameters to assess right ventricular function in pulmonary hypertension. Heart Vessels 32(10):1214–1219CrossRefPubMed
26.
Zurück zum Zitat Hsu S, Kokkonen-Simon KM, Kirk JA, Kolb TM, Damico RL, Mathai SC, Mukherjee M, Shah AA, Wigley FM, Margulies KB, Hassoun PM, Halushka MK, Tedford RJ, Kass DA (2018) Right ventricular myofilament functional differences in humans with systemic sclerosis-associated versus idiopathic pulmonary arterial hypertension. Circulation 137(22):2360–2370CrossRefPubMedPubMedCentral Hsu S, Kokkonen-Simon KM, Kirk JA, Kolb TM, Damico RL, Mathai SC, Mukherjee M, Shah AA, Wigley FM, Margulies KB, Hassoun PM, Halushka MK, Tedford RJ, Kass DA (2018) Right ventricular myofilament functional differences in humans with systemic sclerosis-associated versus idiopathic pulmonary arterial hypertension. Circulation 137(22):2360–2370CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Lindqvist P, Caidahl KC, Neuman-Andersen G, Ozolins C, Rantapaa-Dahlqvist S, Waldenstrom A, Kazaan E (2005) Disturbed right ventricular diastolic function in patients with systemic sclerosis: a doppler tissue imaging study. Chest 128(2):755–763CrossRefPubMed Lindqvist P, Caidahl KC, Neuman-Andersen G, Ozolins C, Rantapaa-Dahlqvist S, Waldenstrom A, Kazaan E (2005) Disturbed right ventricular diastolic function in patients with systemic sclerosis: a doppler tissue imaging study. Chest 128(2):755–763CrossRefPubMed
Metadaten
Titel
Predictors of exercise-induced pulmonary hypertension in patients with connective tissue disease
verfasst von
Sunao Miyanaga
Kayoko Kubota
Noriko Iwatani
Kenjuro Higo
Masaaki Miyata
Yoshihisa Horizoe
Satoko Ojima
Shin Kawasoe
Takuro Kubozono
Mitsuru Ohishi
Publikationsdatum
23.03.2019
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 9/2019
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-019-01373-6

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