title: 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.
abstract: 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.
  
  
  METHODS
  Longitudinal follow-up study.
  
  
  METHODS
  Subjects who were referred for diastolic stress echocardiography.
  
  
  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.
  
  
  METHODS
  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.
authors.affiliation: Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Chi Young
authors.initials: CY
authors.lastname: Shim
authors.forename: Sung-Ai
authors.initials: SA
authors.lastname: Kim
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Woo-In
authors.initials: WI
authors.lastname: Yang
authors.forename: Jin-Mi
authors.initials: JM
authors.lastname: Kim
authors.forename: Sun-Ha
authors.initials: SH
authors.lastname: Moon
authors.forename: Hyun-Jin
authors.initials: HJ
authors.lastname: Lee
authors.forename: Sungha
authors.initials: S
authors.lastname: Park
authors.forename: Eui-Young
authors.initials: EY
authors.lastname: Choi
authors.forename: Namsik
authors.initials: N
authors.lastname: Chung
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Ha
mesh_terms: D000368:Aged; D025401:Echocardiography, Stress; D015444:Exercise; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*