PT  - JOURNAL ARTICLE
AU  - Shim, Chi Young
AU  - Kim, Sung-Ai
AU  - Choi, Donghoon
AU  - Yang, Woo-In
AU  - Kim, Jin-Mi
AU  - Moon, Sun-Ha
AU  - Lee, Hyun-Jin
AU  - Park, Sungha
AU  - Choi, Eui-Young
AU  - Chung, Namsik
AU  - Ha, Jong-Won
TI  - 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
AID  - 10.1136/hrt.2010.220467
DP  - 2011 Sep 01
TA  - Heart
PG  - 1417--1424
VI  - 97
IP  - 17
4099  - http://heart.bmj.com/content/97/17/1417.short
4100  - http://heart.bmj.com/content/97/17/1417.full
SO  - Heart2011 Sep 01; 97
AB  - 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.