Article Text

other Versions

PDF
Determinants of exercise-induced pulmonary hypertension in patients with normal left ventricular ejection fraction
  1. Jong-Won Ha (jwha{at}yuhs.ac)
  1. Yonsei University College of Medicine, Korea, Republic of
    1. Donghoon Choi
    1. Yonsei University College of Medicine, Korea, Republic of
      1. Sungha Park
      1. Yonsei University College of Medicine, Korea, Republic of
        1. Chi-Young Shim
        1. Yonsei University College of Medicine, Korea, Republic of
          1. Jin-Mi Kim
          1. Yonsei University College of Medicine, Korea, Republic of
            1. Seon-Hwa Moon
            1. Yonsei University College of Medicine, Korea, Republic of
              1. Hyun-Jin Lee
              1. Yonsei University College of Medicine, Korea, Republic of
                1. Eui-Young Choi
                1. Yonsei University College of Medicine, Korea, Republic of
                  1. Namsik Chung
                  1. Yonsei University College of Medicine, Korea, Republic of

                    Abstract

                    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: The purpose of this study is to analyze exercise-induced PH determinants in patients with normal LVEF.

                    Methods and Results: Three hundred ninety-six subjects (160 male, mean age 55±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 mmHg. Patients were classified according to exercise induced PH, defined as present if PASP > 50 mmHg at 50 W of exercise. One hundred thirty-five patients (34%) had PASP > 50 mmHg 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 ¡¾ 18 vs 132 ¡¾ 18 mmHg, p=0.0003; 25 W, 146 ¡¾ 21 vs 157 ¡¾ 21 mmHg, p<0.0001; 50 W, 157 ¡¾ 24 vs 170 ¡¾ 22 mmHg, p<0.0001; 75W, 168 ¡¾ 23 vs 183 ¡¾ 22 mmHg, 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.

                    Statistics from Altmetric.com

                    Request permissions

                    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.