PT  - JOURNAL ARTICLE
AU  - J-W Ha
AU  - D Choi
AU  - S Park
AU  - C-Y Shim
AU  - J-M Kim
AU  - S-H Moon
AU  - H-J Lee
AU  - E-Y Choi
AU  - N Chung
TI  - Determinants of exercise-induced pulmonary hypertension in patients with normal left ventricular ejection fraction
AID  - 10.1136/hrt.2007.139295
DP  - 2009 Mar 15
TA  - Heart
PG  - 490--494
VI  - 95
IP  - 6
4099  - http://heart.bmj.com/content/95/6/490.short
4100  - http://heart.bmj.com/content/95/6/490.full
SO  - Heart2009 Mar 15; 95
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.