title: Pressure-Flow During Exercise Catheterization Predicts Survival in Pulmonary Hypertension.
abstract: Pulmonary hypertension manifests with impaired exercise capacity. Our aim was to investigate whether the mean pulmonary arterial pressure to cardiac output relationship (mPAP/CO) predicts transplant-free survival in patients with pulmonary arterial hypertension (PAH) and inoperable chronic thromboembolic pulmonary hypertension (CTEPH).
  
  
  
  Hemodynamic data according to right heart catheterization in patients with PAH and CTEPH at rest and during supine incremental cycle exercise were analyzed. Transplant-free survival and predictive value of hemodynamics were assessed by using Kaplan-Meier and Cox regression analyses.
  
  
  
  Seventy patients (43 female; 54 with PAH, 16 with CTEPH; median (quartiles) age, 65 [50; 73] years; mPAP, 34 [29; 44] mm Hg; cardiac index, 2.8 [2.3; 3.5] [L/min]/m(2)) were followed up for 610 (251; 1256) days. Survival at 1, 3, 5, and 7 years was 89%, 81%, 71%, and 59%. Age, World Health Organization-functional class, 6-min walk test, and mixed-venous oxygen saturation (but not resting hemodynamics) predicted transplant-free survival. Maximal workload (hazard ratio [HR], 0.94 [95% CI, 0.89-0.99]; P = .027), peak cardiac index (HR, 0.51 [95% CI, 0.27-0.95]; P = .034), change in cardiac index, 0.25 [95% CI, 0.06-0.94]; P = .040), and mPAP/CO (HR, 1.02 [95% CI, 1.01-1.03]; P = .003) during exercise predicted survival. Values for mPAP/CO predicted 3-year transplant-free survival with an area under the curve of 0.802 (95% CI, 0.66-0.95; P = .004).
  
  
  
  In this collective of patients with PAH or CTEPH, the pressure-flow relationship during exercise predicted transplant-free survival and correlated with established markers of disease severity and outcome. Right heart catheterization during exercise may provide important complementary prognostic information in the management of pulmonary hypertension.
authors.affiliation: Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Elisabeth D
authors.initials: ED
authors.lastname: Hasler
authors.affiliation: Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Séverine
authors.initials: S
authors.lastname: Müller-Mottet
authors.affiliation: Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Furian
authors.affiliation: Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Saxer
authors.affiliation: Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Lars C
authors.initials: LC
authors.lastname: Huber
authors.affiliation: Clinic of Critical Care Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Maggiorini
authors.affiliation: Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Speich
authors.affiliation: Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland; Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
authors.forename: Konrad E
authors.initials: KE
authors.lastname: Bloch
authors.affiliation: Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland; Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland. Electronic address: silvia.ulrich@usz.ch.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ulrich
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications*; D016019:Survival Analysis; D013557:Switzerland; D014655:Vascular Resistance
keywords: chronic thromboembolic pulmonary hypertension; exercise; hemodynamics; pulmonary arterial hypertension; pulmonary hypertension