title: Pulmonary hypertension in patients with idiopathic pulmonary fibrosis - the predictive value of exercise capacity and gas exchange efficiency.
abstract: Exercise capacity and survival of patients with IPF is potentially impaired by pulmonary hypertension. This study aims to investigate diagnostic and prognostic properties of gas exchange during exercise and lung function in IPF patients with or without pulmonary hypertension. In a multicentre setting, patients with IPF underwent right heart catheterization, cardiopulmonary exercise and lung function testing during their initial evaluation. Mortality follow up was evaluated. Seventy-three of 135 patients [82 males; median age of 64 (56; 72 years)] with IPF had pulmonary hypertension as assessed by right heart catheterization [median mean pulmonary arterial pressure 34 (27; 43) mmHg]. The presence of pulmonary hypertension was best predicted by gas exchange efficiency for carbon dioxide (cut off ≥152% predicted; area under the curve 0.94) and peak oxygen uptake (≤56% predicted; 0.83), followed by diffusing capacity. Resting lung volumes did not predict pulmonary hypertension. Survival was best predicted by the presence of pulmonary hypertension, followed by peak oxygen uptake [HR 0.96 (0.93; 0.98)]. Pulmonary hypertension in IPF patients is best predicted by gas exchange efficiency during exercise and peak oxygen uptake. In addition to invasively measured pulmonary arterial pressure, oxygen uptake at peak exercise predicts survival in this patient population.
authors.affiliation: Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University of Greifswald, Greifswald, Germany. sven.glaeser@uni-greifswald.de
authors.forename: Sven
authors.initials: S
authors.lastname: Gläser
authors.forename: Anne
authors.initials: A
authors.lastname: Obst
authors.forename: Beate
authors.initials: B
authors.lastname: Koch
authors.forename: Beate
authors.initials: B
authors.lastname: Henkel
authors.forename: Anita
authors.initials: A
authors.lastname: Grieger
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Felix
authors.forename: Michael
authors.initials: M
authors.lastname: Halank
authors.forename: Leonhard
authors.initials: L
authors.lastname: Bruch
authors.forename: Tom
authors.initials: T
authors.lastname: Bollmann
authors.forename: Christian
authors.initials: C
authors.lastname: Warnke
authors.forename: Christoph
authors.initials: C
authors.lastname: Schäper
authors.forename: Ralf
authors.initials: R
authors.lastname: Ewert
mesh_terms: D000368:Aged; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D054990:Idiopathic Pulmonary Fibrosis / Q000401:mortality / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011659:Pulmonary Gas Exchange