title: Exercise ventilatory parameters for the diagnosis of reactive pulmonary hypertension in patients with heart failure.
abstract: BACKGROUND
  Reactive pulmonary hypertension (PH) in left heart disease is associated with poor prognosis. This study aimed to evaluate the diagnostic utility of exercise ventilatory parameters on cardiopulmonary exercise testing for the diagnosis of reactive PH in patients with heart failure (HF) and reduced ejection fraction.
  
  
  METHODS
  This was a single-center, retrospective analysis of a prospectively collected database of 131 patients with HF who underwent in-hospital assessment for heart transplantation. Pulmonary hemodynamics was assessed by direct cardiac catheterization. Minute ventilation/carbon dioxide production (VE/VCO2) slope, partial pressure of end-tidal carbon dioxide (ETCO2) changes on exercise, oxygen pulse, and exercise oscillatory ventilation were determined from cardiopulmonary exercise testing.
  
  
  RESULTS
  Sixty-one of 131 consecutive patients had reactive PH. VE/VCO2 slope (>41), change in ETCO2 on exercise (<1.2 mm Hg) and exercise oscillatory ventilation were independently associated with reactive PH. These 3 parameters in combination produced 3 possible diagnostic scenarios: (1) if all 3 criteria ("if all") were present, (2) if any 2 of the 3 criteria ("2 of 3") were present, and (3) if any of the criteria ("if any") were present. The corresponding positive/negative likelihood ratios for reactive PH if all 3 criteria were present were 3.73/0.83, if 2 of the 3 criteria were present were 2.19/0.45, and if any of the 3 criteria were present were 1.75/0.11. The posttest probability increased from 46% to 76% ("if all" present) and reduced to 9% (if none of the criteria was present).
  
  
  CONCLUSIONS
  Ventilatory parameters on cardiopulmonary exercise test are associated with reactive PH in patients with HF. The absence of abnormalities in these 3 ventilatory parameters can effectively exclude reactive PH in patients with HF and poor ejection fraction.
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK. Electronic address: sern.lim@uhb.nhs.uk.
authors.forename: Hoong Sern
authors.initials: HS
authors.lastname: Lim
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Theodosiou
mesh_terms: D002245:Carbon Dioxide / Q000378:metabolism; D006328:Cardiac Catheterization; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis*; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010101:Oxygen Consumption / Q000502:physiology; D011446:Prospective Studies; D012123:Pulmonary Ventilation / Q000502:physiology*; D018924:Vascular Capacitance / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology
chemical_list: D002245:Carbon Dioxide
keywords: Heart failure; pulmonary hypertension