Figures
- FIGURE 1
Flow chart of patient selection. CPET: cardiopulmonary exercise testing; ICU: intensive care unit; LTX: lung transplantation; NT-proBNP: N-terminal pro-brain natriuretic peptide; PEA: pulmonary endarterectomy; RHC: right heart catheterisation; TTE: transthoracic echocardiography.
- FIGURE 2
Correlation analysis of mean pulmonary artery pressure (mPAP) between ICU and 6-month re-evaluation after pulmonary endarterectomy (PEA). Spearman correlation performed. ICU: intensive care unit.
- FIGURE 3
mPAP distribution according to TTE PH probability. Mann–Whitney test performed. mPAP: mean pulmonary artery pressure; PH: pulmonary hypertension; TTE: transthoracic echocardiography.
Tables
- TABLE 1
Pre-operative characteristics
Parameters before PEA Total (n=92) Patients without residual PH after PEA (n=56) Patients with residual PH after PEA (n=36) Age at PEA (years) 63 (range 17–79) 58 (range 18–79) 63 (range 17–79) Women 41 (45%) 24 (43%) 17 (47%) BMI (kg·m−2) 26.7 (24.3–30.1) 26.7 (23.8–30.1) 26.5 (25.0–30.0) Use of PH-specific medication before PEA 27 (29%) 13 (23%) 14 (39%) NYHA class I/II/III/IV (%) 2/38/52/8 4/37/48/11 0/38/59/3 6MWD (m) 412±108, n=67 413±112, n=39 411±105, n=28 NT-proBNP (ng·L−1) 507 (132–1646) 326 (115–1250) 932 (224–2748) Comorbidities Ischaemic heart disease 3 (3%) 0 (0%) 3 (8%) Obstructive lung disease 12 (13%) 6 (11%) 6 (17%) Diabetes mellitus 8 (9%) 5 (9%) 3 (8%) Systemic hypertension 35 (38%) 18 (32%) 17 (47%) Malignancy 6 (7%) 4 (7%) 2 (6%) Thyroid disease 7 (8%) 3 (5%) 4 (11%) Data are presented as mean±sd, median (interquartile range) or n (%) unless otherwise stated. 6MWD: 6-min walk distance; BMI: body mass index; NT-proBNP: N-terminal pro-brain natriuretic peptide; NYHA: New York Heart Association; PEA: pulmonary endarterectomy; PH: pulmonary hypertension.
- TABLE 2
Univariate logistic regression analysis of CPET parameters for residual PH
Parameter OR 95% CI p-value Peak load <80% predicted 4.023 1.434–11.283 0.008 Peak V′O2 <80% predicted 5.386 1.813–16.001 0.002 V′O2/WR <8.4 mL·min−1·W−1 13.417 4.558–39.491 <0.001 O2 pulse <80% predicted 3.154 1.260–7.891 0.014 PETCO2 peak exercise <4.0 kPa 2.667 1.097–6.484 0.030 V′E/V′CO2 AT ≥34.0 4.788 1.866–12.290 0.001 SpO2 peak exercise ≤94% 1.920 0.771–4.781 0.161 AT: anaerobic threshold; CPET: cardiopulmonary exercise testing; PETCO2: end-tidal carbon dioxide partial pressure; PH: pulmonary hypertension; V′E/V′CO2: ventilatory equivalent for carbon dioxide; V′O2: oxygen consumption; SpO2: peripheral oxygen saturation; WR: work rate.
- TABLE 3
Test characteristics of CPET parameters for residual PH
Parameter Sensitivity Specificity PPV False-positive rate Positive LR NPV False-negative rate Negative LR Number-needed-to-catheterise Peak load <80% predicted 28/34 (0.82) 25/54 (0.46) 28/57 (0.49) 29/57 (0.51) 1.53 25/31 (0.81) 6/31 (0.19) 0.38 57/88 (0.65) Peak V′O2 <80% predicted 29/34 (0.85) 26/54 (0.48) 29/57 (0.51) 28/57 (0.49) 1.64 26/31 (0.84) 5/31 (0.16) 0.31 57/88 (0.65) V′O2/WR <8.4 mL·min−1·W−1 23/31 (0.74) 42/51 (0.82) 23/32 (0.72) 9/32 (0.28) 4.20 42/50 (0.84) 8/50 (0.16) 0.31 32/82 (0.39) O2 pulse <80% predicted 17/34 (0.50) 41/54 (0.76) 17/30 (0.57) 13/30 (0.43) 2.08 41/58 (0.71) 17/58 (0.29) 0.66 30/88 (0.34) PETCO2 peak exercise <4.0 kPa 22/34 (0.65) 32/54 (0.59) 22/44 (0.50) 22/44 (0.50) 1.59 32/44 (0.73) 12/44 (0.27) 0.60 44/88 (0.50) V′E/V′CO2 AT ≥34 22/32 (0.69) 37/54 (0.69) 22/39 (0.56) 17/39 (0.44) 2.18 37/47 (0.79) 10/47 (0.21) 0.46 39/86 (0.45) AT: anaerobic threshold; CPET: cardiopulmonary exercise testing; LR: likelihood ratio; NPV: negative predictive value; PETCO2: end-tidal carbon dioxide partial pressure; PH: pulmonary hypertension; PPV: positive predictive value; V′E/V′CO2: ventilatory equivalent for carbon dioxide; V′O2: oxygen consumption; WR: work rate.
