title: Determinants of exercise-induced pulmonary hypertension in patients with normal left ventricular ejection fraction.
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
  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.
authors.affiliation: Cardiology Division, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea. jwha@yuhs.ac
authors.forename: J-W
authors.initials: JW
authors.lastname: Ha
authors.forename: D
authors.initials: D
authors.lastname: Choi
authors.forename: S
authors.initials: S
authors.lastname: Park
authors.forename: C-Y
authors.initials: CY
authors.lastname: Shim
authors.forename: J-M
authors.initials: JM
authors.lastname: Kim
authors.forename: S-H
authors.initials: SH
authors.lastname: Moon
authors.forename: H-J
authors.initials: HJ
authors.lastname: Lee
authors.forename: E-Y
authors.initials: EY
authors.lastname: Choi
authors.forename: N
authors.initials: N
authors.lastname: Chung
mesh_terms: 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
chemical_list: D010100:Oxygen