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

Chi Young Shim, Sung Ai Kim, Donghoon Choi, Woo In Yang, Jin Mi Kim, Sun Ha Moon, Hyun Jin Lee, Sungha Park, Eui Young Choi, Namsik Chung, Jong Won Ha

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52 Citations (Scopus)

Abstract

Objective: To 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. Design: Longitudinal follow-up study. Setting: Subjects who were referred for diastolic stress echocardiography. Patients and methods: The 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 measures: A combination of major cardiovascular events and any cause of death. Results During 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). Conclusions: Exercise-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.

Original languageEnglish
Pages (from-to)1417-1424
Number of pages8
JournalHeart
Volume97
Issue number17
DOIs
Publication statusPublished - 2011 Sep

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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