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. 2024 Jun 28;24(1):306.
doi: 10.1186/s12890-024-03113-7.

Echocardiographic assessment for cardiopulmonary function in patients with congenital heart disease-related pulmonary arterial hypertension

Lifang Yang #  1 , Dongling Luo #  1 , Taoran Huang #  1   2 , Xiaoshan Li  1   3 , Guolin Zhang #  4 , Caojin Zhang #  5 , Hongwen Fei #  6
Affiliations

Echocardiographic assessment for cardiopulmonary function in patients with congenital heart disease-related pulmonary arterial hypertension

Lifang Yang et al. BMC Pulm Med. .

Abstract

Background: For patients with congenital heart disease-related pulmonary arterial hypertension (CHD-PAH), cardiopulmonary exercise testing (CPET) can reflect cardiopulmonary reserve function. However, CPET may not be readily accessible for patients with high-risk conditions or limited mobility due to disability. Echocardiography, on the other hand, serves as a widely available diagnostic tool for all CHD-PAH patients. This study was aimed to identify the parameters of echocardiography that could serve as indicators of cardiopulmonary function and exercise capacity.

Methods: A cohort of 70 patients contributed a total of 110 paired echocardiogram and CPET results to this study, with 1 year interval for repeated examinations. Echocardiography and exercise testing were conducted following standardized procedures, and the data were collected together with clinically relevant indicators for subsequent statistical analysis. Demographic comparisons were performed using t-tests and chi-square tests. Univariate and multivariate analyses were conducted to identify potential predictors of peak oxygen uptake (peak VO2) and the carbon dioxide ventilation equivalent slope (VE/VCO2 slope). Receiver operating characteristic (ROC) analysis was used to assess the performance of the parameters.

Results: The ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) was found to be the only independent indicator significantly associated with both peak VO2 and VE/VCO2 slope (both p < 0.05). Additionally, left ventricular ejection fraction (LVEF) and right ventricular fractional area change (FAC) were independently correlated with the VE/VCO2 slope (both p < 0.05). TAPSE/PASP showed the highest area under the ROC curve (AUC) for predicting both a peak VO2 ≤ 15 mL/kg/min and a VE/VCO2 slope ≥ 36 (AUC = 0.91, AUC = 0.90, respectively). The sensitivity and specificity of TAPSE/PASP at the optimal threshold exceeded 0.85 for both parameters.

Conclusions: TAPSE/PASP may be a feasible echocardiographic indicator for evaluating exercise tolerance.

Keywords: Cardiopulmonary exercise test; Congenital heart disease-related pulmonary arterial hypertension; Echocardiography; Right ventricle-pulmonary arterial coupling.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Linear correlation analysis between echocardiography parameters and the main results of the cardiopulmonary exercise testing (a) Relationship between peak VO2 and TAPSE/PASP. (b) Relationship between VE/VCO2 slope and TAPSE/PASP. (c) Relationship between VE/VCO2 slope and FAC. (d) Relationship between VE/VCO2 slope and LVEF. Abbreviations: TAPSE/PASP, the ratio of tricuspid annular plane systolic excursion and systolic pulmonary arterial pressure; FAC, fractional area change; LVEF, left ventricular ejection fraction
Fig. 2
Fig. 2
Receiver Operating Characteristic curves for predicting peak VO2 ≤ 15 mL/kg/min and VE/VCO2 slope ≥ 36. (a) ROC curve depicting the performance of TAPSE/PASP in predicting peak VO2 ≤ 15 mL/kg/min. (b) ROC curves illustrating the predictive capabilities of TAPSE/PASP, FAC, and LVEF for VE/VCO2 slope ≥ 36. Abbreviations: TAPSE/PASP, the ratio of tricuspid annular plane systolic excursion and systolic pulmonary arterial pressure; FAC, fractional area change
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