Higashi Akifumi, Dohi Yoshihiro, Yamabe Sayuri, Kinoshita Hiroki, Sada Yoshiharu, Kitagawa Toshiro, Hidaka Takayuki, Kurisu Satoshi, Yamamoto Hideya, Yasunobu Yuji, Kihara Yasuki
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
Department of Cardiovascular Medicine, Onomichi General Hospital, Onomichi, Japan.
Heart Vessels. 2017 Nov;32(11):1350-1357. doi: 10.1007/s00380-017-0999-y. Epub 2017 May 30.
Cardiopulmonary exercise testing (CPET) is useful for the evaluation of patients with suspected or confirmed pulmonary hypertension (PH). End-tidal carbon dioxide pressure (PETCO) during exercise is reduced with elevated pulmonary artery pressure. However, the utility of ventilatory parameters such as CPET for detecting PH remains unclear. We conducted a review in 155 patients who underwent right heart catheterization and CPET. Fifty-nine patients had PH [mean pulmonary arterial pressure (mPAP) ≥25 mmHg]. There was an inverse correlation between PETCO at the anaerobic threshold (AT) and mPAP (r = -0.66; P < 0.01). Multiple regression analysis showed that PETCO at the AT was independently associated with an elevated mPAP (P = 0.04). The sensitivity and specificity of CPET for PH were 80 and 86%, respectively, when the cut-off value identified by receiver operating characteristic curve analysis for PETCO at the AT was ≤34.7 mmHg. A combination of echocardiography and CPET improved the sensitivity in detecting PH without markedly reducing specificity (sensitivity 87%, specificity 85%). Evaluation of PETCO at the AT is useful for estimating pulmonary pressure. A combination of CPET and previous screening algorithms for PH may enhance the diagnostic ability of PH.
心肺运动试验（CPET）对于评估疑似或确诊肺动脉高压（PH）的患者很有用。运动期间的呼气末二氧化碳分压（PETCO）会随着肺动脉压力升高而降低。然而，诸如CPET等通气参数在检测PH方面的效用仍不明确。我们对155例行右心导管检查和CPET的患者进行了一项回顾性研究。59例患者患有PH [平均肺动脉压（mPAP）≥25 mmHg]。无氧阈（AT）时的PETCO与mPAP呈负相关（r = -0.66；P < 0.01）。多元回归分析显示，AT时的PETCO与mPAP升高独立相关（P = 0.04）。当通过AT时PETCO的受试者工作特征曲线分析确定的临界值≤34.7 mmHg时，CPET检测PH的敏感性和特异性分别为80%和86%。超声心动图和CPET联合应用可提高检测PH的敏感性，而不会显著降低特异性（敏感性87%，特异性85%）。评估AT时的PETCO有助于估计肺动脉压力。CPET与先前的PH筛查算法相结合可能会提高PH的诊断能力。
