TY - JOUR
T1 - Determinants of exercise-induced pulmonary hypertension in patients with normal left ventricular ejection fraction
AU - Ha, Jong Won
AU - Choi, D.
AU - Park, S.
AU - Shim, C. Y.
AU - Kim, J. M.
AU - Moon, S. H.
AU - Lee, H. J.
AU - Choi, E. Y.
AU - Chung, N.
PY - 2009/3
Y1 - 2009/3
N2 - Background: Pulmonary hypertension (PH) can occur during exercise and has an adverse effect on functional status, exercise tolerance and prognosis. However, the role of cardiac function abnormalities on exercise-induced PH in patients with normal left ventricular ejection fraction (LVEF) is unclear. Objective: To analyse exercise-induced PH determinants in patients with normal LVEF. Methods and results: 396 subjects (160 male, mean age 55 (SD 13)) referred for exercise echocardiography underwent a graded, symptom-limited, supine bicycle exercise with two-dimensional and Doppler echocardiography. Tricuspid regurgitation (TR) velocity was measured at rest and during exercise. Pulmonary artery systolic pressure (PASP) was estimated from TR velocity by adding a right atrial pressure of 10 mm Hg. Patients were classified according to exercise induced PH, defined as present if PASP >50 mm Hg at 50 W of exercise. 135 patients (34%) had PASP >50 mm Hg during exercise. Patients with exercise-induced PH were older, more commonly female and had shorter exercise duration; however, LVEF was significantly higher. The systolic blood pressure at rest and during exercise was significantly higher in patients with exercise-induced PH (rest, 125 (18) vs 132 (18) mm Hg, p = 0.0003; 25 W, 146 (21) vs 157 (21) mm Hg, p<0.0001; 50 W, 157 (24) vs 170 (22) mm Hg, p<0.0001; 75 W, 168 (23) vs 183 (22) mm Hg, p<0.0001). Despite similar resting oxygen saturation, exercise oxygen saturation was significantly lower in subjects with exercise-induced PH than in those without. Numerous echocardiographic variables were significantly different between groups. In multivariate analysis, resting TR velocity (p<0.0001), E/E′ (p = 0.027), age and gender were the strongest predictors of PASP during exercise. Conclusion: Exercise-induced PH is common even in subjects with normal LVEF. It is strongly associated with E/E′ ratio, TR velocity, age, systolic blood pressure during exercise and gender.
AB - Background: Pulmonary hypertension (PH) can occur during exercise and has an adverse effect on functional status, exercise tolerance and prognosis. However, the role of cardiac function abnormalities on exercise-induced PH in patients with normal left ventricular ejection fraction (LVEF) is unclear. Objective: To analyse exercise-induced PH determinants in patients with normal LVEF. Methods and results: 396 subjects (160 male, mean age 55 (SD 13)) referred for exercise echocardiography underwent a graded, symptom-limited, supine bicycle exercise with two-dimensional and Doppler echocardiography. Tricuspid regurgitation (TR) velocity was measured at rest and during exercise. Pulmonary artery systolic pressure (PASP) was estimated from TR velocity by adding a right atrial pressure of 10 mm Hg. Patients were classified according to exercise induced PH, defined as present if PASP >50 mm Hg at 50 W of exercise. 135 patients (34%) had PASP >50 mm Hg during exercise. Patients with exercise-induced PH were older, more commonly female and had shorter exercise duration; however, LVEF was significantly higher. The systolic blood pressure at rest and during exercise was significantly higher in patients with exercise-induced PH (rest, 125 (18) vs 132 (18) mm Hg, p = 0.0003; 25 W, 146 (21) vs 157 (21) mm Hg, p<0.0001; 50 W, 157 (24) vs 170 (22) mm Hg, p<0.0001; 75 W, 168 (23) vs 183 (22) mm Hg, p<0.0001). Despite similar resting oxygen saturation, exercise oxygen saturation was significantly lower in subjects with exercise-induced PH than in those without. Numerous echocardiographic variables were significantly different between groups. In multivariate analysis, resting TR velocity (p<0.0001), E/E′ (p = 0.027), age and gender were the strongest predictors of PASP during exercise. Conclusion: Exercise-induced PH is common even in subjects with normal LVEF. It is strongly associated with E/E′ ratio, TR velocity, age, systolic blood pressure during exercise and gender.
UR - http://www.scopus.com/inward/record.url?scp=61949463924&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=61949463924&partnerID=8YFLogxK
U2 - 10.1136/hrt.2007.139295
DO - 10.1136/hrt.2007.139295
M3 - Article
C2 - 18653569
AN - SCOPUS:61949463924
SN - 1355-6037
VL - 95
SP - 490
EP - 494
JO - Heart
JF - Heart
IS - 6
ER -