title: Experience with exercise right heart catheterization in the diagnosis of pulmonary hypertension: a retrospective study.
abstract: BACKGROUND
  Data on exercise pulmonary hemodynamics in healthy people and patients with pulmonary hypertension (PH) are rare. We analyzed exercise right heart catheterization (RHC) data in a symptomatic collective referred with suspected PH to characterize the differential response by diagnostic groups, to correlate resting with exercise hemodynamics, and to evaluate safety.
  
  
  METHODS
  This is a retrospective single-center study reviewing data from patients in whom an exercise RHC was performed between January 2006 and January 2013. Patients with follow-up RHC under PH -therapy were excluded.
  
  
  RESULTS
  Data from 101 patients were analyzed, none of them had an adverse event. In 35% we detected a resting PH (27.8% precapillary, 6.9% postcapillary). Exercise PH (mean pulmonary arterial pressure (mPAP) >30 mmHg at exercise) was found in 38.6%, whereas in 25.7% PH was excluded. We found a remarkable number of exercise PH in scleroderma patients, the majority being postcapillary. 83% of patients with mPAP-values between 20 and 24.9 mmHg at rest had exercise PH. Patients with resting PH had worse hemodynamics and were older compared with exercise PH ones.
  
  
  CONCLUSIONS
  In this real-life experience in symptomatic patients undergoing exercise RHC for suspected PH, we found that exercise RHC is safe. The facts that the vast majority of patients with mPAP-values between 20 and 24.9 mmHg at rest had exercise PH and the older age of patients with resting PH may indicate that exercise PH is a precursor of resting PH. Whether earlier treatment start in patients with exercise PH would stabilize the disease should be addressed in future studies.
authors.affiliation: Clinic of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Keusch
authors.affiliation: Clinic of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland.
authors.forename: Anina
authors.initials: A
authors.lastname: Bucher
authors.affiliation: Clinic of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland.
authors.forename: Séverine
authors.initials: S
authors.lastname: Müller-Mottet
authors.affiliation: Clinic of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hasler
authors.affiliation: Clinic for Internal Medicine, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Maggiorini
authors.affiliation: Clinic for Internal Medicine, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Speich
authors.affiliation: Clinic of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland ; Zurich Center for Integrative Human Physiology, Zurich, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ulrich
keywords: Exercise; Pulmonary arterial hypertension; Pulmonary hypertension; Right heart catheterization