title: Simple exercise echocardiography using a Master's two-step test for early detection of pulmonary arterial hypertension.
abstract: BACKGROUND
  Early detection of pulmonary arterial hypertension (PAH) is indispensable, although, echocardiography at rest alone does not provide sufficient evidence for it. Here, this study aimed to investigate the usefulness of simple exercise echocardiography using a Master's two-step test for detecting early PAH.
  
  
  METHODS
  This study included 52 connective tissue disease patients who had mild symptoms in World Health Organization functional classification 2, suspected as having early PAH, and underwent exercise echocardiography and right heart catheterization. Echocardiography was performed before and after the Master's two-step exercise test; the study patients were classified into the non-PAH (mean pulmonary arterial pressure <25 mmHg, n=37) or PAH (mean pulmonary arterial pressure ≥25 mmHg, n=15) groups.
  
  
  RESULTS
  Rest systolic pulmonary artery pressure estimated using echocardiography did not significantly differ between the two groups; however, a significant difference in post-exercise systolic pulmonary artery pressure was found (non-PAH, 58.8±10.8 mmHg; PAH, 80.2±14.3 mmHg, p<0.0001). The multiple logistic regression analysis indicated post-exercise systolic pulmonary artery pressure as an independent predictor of PAH (p=0.013). The area under the curve by post-exercise systolic pulmonary artery pressure was 0.91 for PAH. Post-exercise systolic pulmonary artery pressure ≥69.6 mmHg predicted PAH with the sensitivity of 93% and the specificity of 90%.
  
  
  CONCLUSIONS
  Simple exercise echocardiography using the Master's two-step test could detect PAH in mildly symptomatic connective tissue disease patients. The usefulness of this method should be verified for the early detection of PAH.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan. Electronic address: kengo@marianna-u.ac.jp.
authors.forename: Kengo
authors.initials: K
authors.lastname: Suzuki
authors.forename: Yoshihiro J
authors.initials: YJ
authors.lastname: Akashi
authors.forename: Mariko
authors.initials: M
authors.lastname: Manabe
authors.forename: Kei
authors.initials: K
authors.lastname: Mizukoshi
authors.forename: Ryo
authors.initials: R
authors.lastname: Kamijima
authors.forename: Seisyou
authors.initials: S
authors.lastname: Kou
authors.forename: Manabu
authors.initials: M
authors.lastname: Takai
authors.forename: Masaki
authors.initials: M
authors.lastname: Izumo
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kida
authors.forename: Kihei
authors.initials: K
authors.lastname: Yoneyama
authors.forename: Kazuto
authors.initials: K
authors.lastname: Omiya
authors.forename: Yoshioki
authors.initials: Y
authors.lastname: Yamasaki
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Yamada
authors.forename: Sachihiko
authors.initials: S
authors.lastname: Nobuoka
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miyake
mesh_terms: D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D042241:Early Diagnosis; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000145:classification / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000503:physiopathology; D012680:Sensitivity and Specificity
keywords: Exercise tests; Pulmonary hypertension; Stress echocardiography