Clinical outcomes of exercise-induced pulmonary hypertension in subjects with preserved left ventricular ejection fraction: implication of an increase in left ventricular filling pressure during exercise

• Published in: Heart (British Cardiac Society) Vol. 97; no. 17; pp. 1417 - 1424
• Main Authors: Shim, Chi Young, Kim, Sung-Ai, Choi, Donghoon, Yang, Woo-In, Kim, Jin-Mi, Moon, Sun-Ha, Lee, Hyun-Jin, Park, Sungha, Choi, Eui-Young, Chung, Namsik, Ha, Jong-Won
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.09.2011; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular system; Clinical outcomes; diastolic dysfunction; Disease; Echocardiography, Stress; echocardiography-exercise; Exercise; Female; Heart attacks; Heart failure; Humans; Hypertension; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Pneumology; prognosis; pulmonary; pulmonary arterial hypertension (PAH); Pulmonary hypertension; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Retrospective Studies; Stroke Volume; Studies; Variables; Velocity; Ventricular Dysfunction, Left - physiopathology; Workloads; Physical exercise; Human; Prognosis; Respiratory disease; Cardiovascular disease; Increase; Pressure; Pulmonary hypertension; Left ventricle; Exercise tolerance test; Ventricular ejection; Filling; Circulatory system; Hemodynamics; Cardiology; Ejection fraction
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2010.220467

ObjectiveTo investigate clinical outcomes of exercise-induced pulmonary hypertension (PH) and implications of an increase in left ventricular (LV) filling pressure during exercise in subjects with preserved LV ejection fraction.DesignLongitudinal follow-up study.SettingSubjects who were referred for diastolic stress echocardiography.Patients and methodsThe ratio of transmitral and annular velocities (E/Ea) and pulmonary artery systolic pressure (PASP) at rest and during exercise were measured in 498 subjects (57±11 years; 201 male). Exercise-induced PH was defined as present if PASP ≥50 mm Hg at 50 W of exercise, and an increase in LV filling pressure during exercise was present if E/Ea ≥15 at 50 W.Main outcome measuresA combination of major cardiovascular events and any cause of death.ResultsDuring a median follow-up of 41 months, there were 14 hospitalisations and four deaths. Subjects with exercise-induced PH had significantly worse clinical outcomes than those without (p=0.014). Subjects with exercise-induced PH associated with an increase in E/Ea during exercise had significantly worse outcomes than other groups (p<0.001). However, prognosis was similar between subjects with exercise-induced PH without an increase in E/Ea and those without exercise-induced PH. In subjects with exercise-induced PH, E/Ea at 50 W was an independent predictor of adverse outcomes (HR 1.37; 95% CI 1.02 to 1.83; p=0.036).ConclusionsExercise-induced PH provides prognostic information in subjects with preserved LV ejection fraction. The excess risk of exercise-induced PH is restricted to subjects with an increase in estimated LV filling pressure during exercise.