title: Cardiopulmonary exercise testing as a diagnostic tool for the detection of left-sided pulmonary hypertension in heart failure.
abstract: BACKGROUND
  Recently, it has become increasingly recognized that pulmonary hypertension (PH) is a particularly ominous consequence of left-sided heart failure (HF). The primary aim of this investigation was to assess the ability of key cardiopulmonary exercise testing (CPX) variables to detect elevated pulmonary pressures in a HF cohort.
  
  
  METHODS
  This was a retrospective analysis of a prospectively collected database. Two hundred ninety-three subjects with HF (63 ± 10 years old, 79% male) underwent Doppler echocardiography to estimate resting pulmonary artery systolic pressure (PASP). Peak oxygen consumption (VO2), the minute ventilation/carbon dioxide production (VE/VCO2) slope, peak partial pressure of end-tidal CO2 (PETCO2) and exercise oscillatory ventilation (EOV) were determined.
  
  
  RESULTS
  Forty-six percent (n = 134) of the subjects presented with a PASP ≥ 40 mm Hg. A VE/VCO2 slope </≥ 36.0 was the best predictor of a PASP ≥ 40 mm Hg (odds ratio [OR] 12.1, 95% confidence interval [CI] 6.8-21.4; P < .001). Peak PETCO2 ≤ 34 mm Hg (OR 3.8, 95% CI 1.3-11.2; P < .001) and the presence of EOV (OR 3.2, 95% CI 1.8-5.8; P < .001) added significant diagnostic value.
  
  
  CONCLUSIONS
  Although CPX is an established prognostic assessment in the HF population, the results of the present investigation indicate that it may also have important diagnostic utility for PH.
authors.affiliation: Cardiology, IRCCS Policlinico San Donato, University of Milano, San Donato Milanese, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Guazzi
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Cahalin
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
mesh_terms: D000368:Aged; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology
keywords: Ventilatory efficacy; diagnosis; pulmonary hemodynamics