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Pulmonary hypertension
Determinants of exercise-induced pulmonary hypertension in patients with normal left ventricular ejection fraction
  1. J-W Ha,
  2. D Choi,
  3. S Park,
  4. C-Y Shim,
  5. J-M Kim,
  6. S-H Moon,
  7. H-J Lee,
  8. E-Y Choi,
  9. N Chung
  1. Cardiology Division, Yonsei University College of Medicine, Seoul, South Korea
  1. Dr Jong-Won Ha, Cardiology Division, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea; jwha{at}


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.

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  • Funding: This work was supported by the Korea Science and Engineering Foundation (KOSEF) grant funded by the Korean government (M10642120001-06N4212-00110).

  • Competing interests: None.