Dataset Information

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.

SUBMITTER: Ho JE

PROVIDER: S-EPMC7043927 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

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

Ho Jennifer E JE Zern Emily K EK Lau Emily S ES Wooster Luke L Bailey Cole S CS Cunningham Thomas T Eisman Aaron S AS Hardin Kathryn M KM Farrell Robyn R Sbarbaro John A JA Schoenike Mark W MW Houstis Nicholas E NE Baggish Aaron L AL Shah Ravi V RV Nayor Matthew M Malhotra Rajeev R Lewis Gregory D GD

Journal of the American College of Cardiology 20200101 1

<h4>Background</h4>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.<h4>Objectives</h4>This study sought to investigate the association of exPH with clinical determinants and outcomes.<h4>Methods</h4>The authors studied individuals with chronic exertional dyspnea and preserved ejection fraction who underwent cardi ...[more]

PMID: 31918830

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Dataset Information

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

Background

Objectives

Methods

Results

Conclusions

Publications

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

Similar Datasets

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