Determinants of exercise-induced pulmonary hypertension in patients with normal left ventricular ejection fraction.
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.


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.


CONCLUSIONS
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.
Ha
J-W
JW
Cardiology Division, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea. jwha@yuhs.ac
Choi
D
D
Park
S
S
Shim
C-Y
CY
Kim
J-M
JM
Moon
S-H
SH
Lee
H-J
HJ
Choi
E-Y
EY
Chung
N
N
D000328:Adult; D000367:Age Factors; D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure; D015150:Echocardiography, Doppler / Q000379:methods; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology; D016277:Ventricular Function, Left
D010100:Oxygen