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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.
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.
摘要：
背景：对于患有先天性心脏病相关肺动脉高压（CHD-PAH）的患者，心肺运动试验（CPET）可以反映心肺储备功能。然而,对于高危疾病或因残疾而行动不便的患者，CPET可能不容易获得。超声心动图,另一方面,作为所有CHD-PAH患者的广泛可用的诊断工具。本研究旨在确定可以作为心肺功能和运动能力指标的超声心动图参数。
方法：一个由70名患者组成的队列为这项研究贡献了110个配对的超声心动图和CPET结果，以1年的间隔重复检查。超声心动图和运动测试按照标准化程序进行，数据与临床相关指标一起收集,用于后续统计分析.使用t检验和卡方检验进行人口统计学比较。进行了单变量和多变量分析，以确定峰值摄氧量（峰值VO2）和二氧化碳通气当量斜率（VE/VCO2斜率）的潜在预测因子。接收器工作特性（ROC）分析用于评估参数的性能。
结果：发现三尖瓣环平面收缩期偏移与肺动脉收缩压之比（TAPSE/PASP）是唯一与峰值VO2和VE/VCO2斜率显著相关的独立指标（均p<0.05）。此外,左心室射血分数（LVEF）和右心室面积变化（FAC）与VE/VCO2斜率独立相关（均p<0.05）。TAPSE/PASP显示出最高的ROC曲线下面积（AUC），用于预测峰值VO2≤15mL/kg/min和VE/VCO2斜率≥36（分别为AUC=0.91，AUC=0.90）。对于这两个参数，TAPSE/PASP在最佳阈值的敏感性和特异性均超过0.85。
结论：TAPSE/PASP可能是评估运动耐量的可行超声心动图指标。
方法：一个由70名患者组成的队列为这项研究贡献了110个配对的超声心动图和CPET结果，以1年的间隔重复检查。超声心动图和运动测试按照标准化程序进行，数据与临床相关指标一起收集,用于后续统计分析.使用t检验和卡方检验进行人口统计学比较。进行了单变量和多变量分析，以确定峰值摄氧量（峰值VO2）和二氧化碳通气当量斜率（VE/VCO2斜率）的潜在预测因子。接收器工作特性（ROC）分析用于评估参数的性能。
结果：发现三尖瓣环平面收缩期偏移与肺动脉收缩压之比（TAPSE/PASP）是唯一与峰值VO2和VE/VCO2斜率显著相关的独立指标（均p<0.05）。此外,左心室射血分数（LVEF）和右心室面积变化（FAC）与VE/VCO2斜率独立相关（均p<0.05）。TAPSE/PASP显示出最高的ROC曲线下面积（AUC），用于预测峰值VO2≤15mL/kg/min和VE/VCO2斜率≥36（分别为AUC=0.91，AUC=0.90）。对于这两个参数，TAPSE/PASP在最佳阈值的敏感性和特异性均超过0.85。
结论：TAPSE/PASP可能是评估运动耐量的可行超声心动图指标。
