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Exercise Pulmonary Hypertension Predicts Clinical Outcomes in Patients With Dyspnea on Effort.

Abstract：

BACKGROUND:Abnormal pulmonary arterial pressure (PAP) responses to exercise have been described in select individuals; however, clinical and prognostic implications of exercise pulmonary hypertension (exPH) among broader samples remains unclear. OBJECTIVES:This study sought to investigate the association of exPH with clinical determinants and outcomes. METHODS:The authors studied individuals with chronic exertional dyspnea and preserved ejection fraction who underwent cardiopulmonary exercise testing with invasive hemodynamic monitoring. Exercise pulmonary hypertension was ascertained using minute-by-minute PAP and cardiac output (CO) measurements to calculate a PAP/CO slope, and exPH defined as a PAP/CO slope >3 mm Hg/l/min. The primary outcome was cardiovascular (CV) hospitalization or all-cause mortality. RESULTS:Among 714 individuals (age 57 years, 59% women), 296 (41%) had abnormal PAP/CO slopes. Over a mean follow-up of 3.7 ± 2.9 years, there were 208 CV or death events. Individuals with abnormal PAP/CO slope had a 2-fold increased hazard of future CV or death event (multivariable-adjusted hazard ratio: 2.03; 95% confidence interval: 1.48 to 2.78; p < 0.001). The association of abnormal PAP/CO slope with outcomes remained significant after excluding rest PH (n = 146, hazard ratio: 1.75; 95% confidence interval: 1.21 to 2.54; p = 0.003). Both pre- and post-capillary contributions to exPH independently predicted adverse events (p < 0.001 for both). CONCLUSIONS:Exercise pulmonary hypertension is independently associated with CV event-free survival among individuals undergoing evaluation of chronic dyspnea. These findings suggest incremental value of exercise hemodynamic assessment to resting measurements alone in characterizing the burden of PH in individuals with dyspnea. Whether PH and PH subtypes unmasked by exercise can be used to guide targeted therapeutic interventions requires further investigation.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Ho JE,Zern EK,Lau ES,Wooster L,Bailey CS,Cunningham T,Eisman AS,Hardin KM,Farrell R,Sbarbaro JA,Schoenike MW,Houstis NE,Baggish AL,Shah RV,Nayor M,Malhotra R,Lewis GD

doi

10.1016/j.jacc.2019.10.048

subject

Has Abstract

pub_date

2020-01-07 00:00:00

pages

17-26

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(19)38383-4

journal_volume

pub_type

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Exercise Pulmonary Hypertension Predicts Clinical Outcomes in Patients With Dyspnea on Effort.