Clinical characteristics and determinants of exercise-induced pulmonary hypertension in patients with preserved left ventricular ejection fraction.
OBJECTIVE
Recent studies have shown that exercise-induced pulmonary hypertension (EIPH) is not rare in patients with preserved left ventricular ejection fraction (LVEF). However, the determinants and clinical implication of EIPH in these patients are unclear.


RESULTS
This study included 1383 patients who were referred for exercise echocardiography to evaluate unexplained exertional dyspnoea or chest discomfort. Pulmonary artery systolic pressure (PASP) was estimated from the maximal velocity of the tricuspid regurgitant jet added to a right atrial pressure of 10 mmHg. EIPH was defined as PASP ≥50 mmHg during exercise. The EIPH group consisted of about one-third of all patients (436 patients, 31.5%). Patients with EIPH were older, more commonly male and had shorter exercise times. In resting echocardiographic findings, the patients with EIPH had worse diastolic function associated with a lower e' value (7.0 ± 2.0 vs. 7.5 ± 2.3 cm/s, P< 0.001), a longer deceleration time (238.9 ± 54.9 vs. 232.8 ± 46.0 ms, P= 0.043), and a higher E/e' ratio (10.1 ± 2.9 vs. 9.1 ± 2.7, P< 0.001) compared with those without EIPH. In multivariable analysis, age (P< 0.001), resting E/e' ratio (P< 0.001), and resting PASP (P< 0.001) were identified as independent determinants of EIPH.


CONCLUSIONS
EIPH was documented in one-third of patients with preserved LVEF. Age, resting E/e' ratio, and resting PASP were independently associated with EIPH. Therefore, EIPH should be considered as a cause of unexplained exercise intolerance in patients with preserved LVEF.
A Young
AY
Lim
Chunghun
C
Kim
Sung-Ji
SJ
Park
Jin-Oh
JO
Choi
Sang-Chol
SC
Lee
Seung Woo
SW
Park
D000367:Age Factors; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology; D015331:Cohort Studies; D016208:Databases, Factual; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D025401:Echocardiography, Stress / Q000009:adverse effects*; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012016:Reference Values; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*
echocardiography; exercise; pulmonary hypertension