From the Guidelines
When testing for pulmonary vascular disease, a stress test such as exercise stress echocardiography or cardiopulmonary exercise testing (CPET) should be performed to assess pulmonary artery pressure and right ventricular function. This is based on the most recent and highest quality study, which recommends the use of stress echocardiography in evaluating patients with known or suspected pulmonary hypertension 1.
Key Considerations
- The stress test should be performed with graded semi-supine exercise and imaging acquisition to assess pulmonary artery pressure and right ventricular function.
- Doppler recordings should be obtained within 1 min of test completion to accurately measure pulmonary artery pressure.
- The administration of a hypoxic challenge may be used as an alternative stress test in patients at risk for pulmonary hypertension or high altitude pulmonary edema.
- The minimum acquired dataset should include tricuspid regurgitation velocity, pulmonary regurgitation velocity, and right ventricular size and function.
Clinical Significance
- An elevation in pulmonary artery pressure and/or the development of right ventricular dysfunction with exercise has notable clinical significance, generally denoting a poorer prognosis.
- The presence of a patent foramen ovale and right-to-left shunting can also be diagnosed with the assistance of CPET while the patient respires 100% oxygen.
- Exercise testing should be approached cautiously, especially in patients with primary pulmonary hypertension, and may not be indicated in patients with recent history of syncope or arrhythmias, and/or when signs of right-heart failure are present 1.
Recommendations
- CPET can be performed safely in patients with pulmonary vascular disease for functional and prognostic evaluation, but requires careful risk-benefit analysis.
- Resting hemodynamic data may suffice in monitoring response to treatment, but exercise testing provides complementary information in the evaluation of patients with pulmonary vascular disease.
- The use of stress echocardiography or CPET can help identify patients with pulmonary vascular disease and guide management decisions to improve morbidity, mortality, and quality of life.
From the Research
PVST Test
- The provided studies do not directly mention the PVST test, however, they discuss various methods for diagnosing and managing deep venous thrombosis (DVT) and venous thromboembolism (VTE) [(2,3,4,5)].
- Compression ultrasound (CUS) is highlighted as a key diagnostic tool for DVT due to its high accuracy, ease of use, and safety profile 2.
- Other imaging modalities such as CT venography and intravascular ultrasound are also discussed in the context of DVT diagnosis and management [(3,4)].
- The importance of considering both the benefits and risks of medical imaging is emphasized, rather than focusing solely on risk 6.
- Ultrasound surveillance for DVT is explored as a potential strategy for reducing the incidence of pulmonary embolism in high-risk patients, such as those with trauma 5.