TAPSE/sPAP at peak exercise as a surrogate of RV-PA uncoupling can predict exercise-induced pulmonary hypertension in symptomatic patients with chronic thromboembolic pulmonary disease

Abstract Background and aim Chronic thromboembolic disease (CTED) refers to the presence of chronic thrombotic pulmonary vascular occlusion in the absence of pulmonary hypertension (PH) at rest but with exercise limitation caused by established vasculopathy. Symptoms after an acute pulmonary embolism (PE) with persistent lung perfusion defects need a complete diagnostic approach. Exercise echocardiography (ex-echo), with surrogate parameters of ventricular-arterial (VA) coupling could be of interest to non-invasively assess a pathological hemodynamic response. The aim of this study is to analyze the role of ex-echo and non-invasive assessment of VA coupling by echocardiography in predicting an abnormal hemodynamic response in symptomatic patients with chronic thrombotic pulmonary vascular occlusion. Methods Symptomatic patients with confirmed perfusion defects in lung V/Q scintigraphy despite optimal anticoagulant therapy for at least 3 months after an acute PE were selected. Relevant PH at rest was ruled-out (mPAP