Prognostic value of exercise pulmonary haemodynamics in pulmonary arterial hypertension.
The aim of the study was to investigate the prognostic value of right heart catheterisation variables measured during exercise. 55 incident patients with idiopathic, familial or anorexigen-associated pulmonary arterial hypertension (PAH) underwent right heart catheterisation at rest and during exercise and 6-min walk testing before PAH treatment initiation. Patients were treated according to recommendations within the next 2 weeks. Right heart catheterisation was repeated 3-5 months into the PAH treatment in 20 patients. Exercise cardiac index decreased gradually as New York Heart Association (NYHA) functional class increased whereas cardiac index at rest was not significantly different across NYHA groups. Baseline 6-min walk distance correlated significantly with exercise and change in cardiac index from rest to exercise (r=0.414 and r=0.481, respectively; p<0.01). Change in 6-min walk distance from baseline to 3-5 months under PAH treatment was highly correlated with change in exercise cardiac index (r=0.746, p<0.001). The most significant baseline covariates associated with survival were change in systolic pulmonary artery pressure from rest to exercise and exercise cardiac index (hazard ratio 0.56 (95% CI 0.37-0.86) and 0.14 (95% CI 0.05-0.43), respectively). Change in pulmonary haemodynamics during exercise is an important tool for assessing disease severity and may help devise optimal treat-to-target strategies.
CHU Nancy, Pôle des spécialités médicales/Département de Pneumologie, Vandoeuvre-lès-Nancy, France Université de Lorraine, INGRES, EA 7298, Vandoeuvre-lès-Nancy, France a.chaouat@chu-nancy.fr.
Ari
A
Chaouat
AP-HP, CHU de Bicêtre, Service de Pneumologie, Centre de Référence de l'hypertension pulmonaire sévère, DHU TORINO, Le Kremlin-Bicêtre, France Université Paris-Sud, INSERM U999, Le Kremlin-Bicêtre, France.
Olivier
O
Sitbon
CHU Nancy, Pôle des spécialités médicales/Département de Pneumologie, Vandoeuvre-lès-Nancy, France.
Magalie
M
Mercy
CHU Nancy, Pôle des spécialités médicales/Département de Pneumologie, Vandoeuvre-lès-Nancy, France.
Raphaëlle
R
Ponçot-Mongars
Pulmonary Hypertension Research Group, Centre de recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada.
Steeve
S
Provencher
CHU Nancy, Pôle des spécialités médicales/Département de Pneumologie, Vandoeuvre-lès-Nancy, France.
Anne
A
Guillaumot
CHU Nancy, Pôle des spécialités médicales/Département de Pneumologie, Vandoeuvre-lès-Nancy, France.
Emmanuel
E
Gomez
CHU Nancy, Département de Cardiologie, Vandoeuvre-lès-Nancy, France.
Christine
C
Selton-Suty
CHU Nancy, Pôle des spécialités médicales/Département de Pneumologie, Vandoeuvre-lès-Nancy, France.
Pascale
P
Malvestio
CHU Nancy, Pôle imagerie/Radiologie, Vandoeuvre-lès-Nancy, France.
Denis
D
Regent
Université de Lorraine, INGRES, EA 7298, Vandoeuvre-lès-Nancy, France CHU Nancy, Pôle des spécialités médicales/Pathologie Professionnelle, Vandoeuvre-lès-Nancy, France.
Christophe
C
Paris
Centre Chirurgical Marie-Lannelongue, Service des Explorations Fonctionnelles, Le Plessis-Robinson, France.
Philippe
P
Hervé
CHU Nancy, Pôle des spécialités médicales/Département de Pneumologie, Vandoeuvre-lès-Nancy, France Université de Lorraine, INGRES, EA 7298, Vandoeuvre-lès-Nancy, France.
François
F
Chabot
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D006328:Cardiac Catheterization; D015444:Exercise; D005080:Exercise Test; D065627:Familial Primary Pulmonary Hypertension / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D016138:Walking