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Clinical outcomes of exercise-induced pulmonary hypertension in subjects with preserved left ventricular ejection fraction: implication of an increase in left ventricular filling pressure during exercise

Authors
 Chi Young Shim ; Sung-Ai Kim ; Jong-Won Ha ; Namsik Chung ; Eui-Young Choi ; Sungha Park ; Hyun-Jin Lee ; Sun-Ha Moon ; Jin-Mi Kim ; Woo-In Yang ; Donghoon Choi 
Citation
 Heart, Vol.97(17) : 1417~1424, 2011 
Journal Title
 Heart 
ISSN
 1355-6037 
Issue Date
2011
Abstract
OBJECTIVE: To investigate clinical outcomes of exercise-induced pulmonary hypertension (PH) and implications of an increase in left ventricular (LV) filling pressure during exercise in subjects with preserved LV ejection fraction. DESIGN: Longitudinal follow-up study. SETTING: Subjects who were referred for diastolic stress echocardiography. PATIENTS AND METHODS: The ratio of transmitral and annular velocities (E/Ea) and pulmonary artery systolic pressure (PASP) at rest and during exercise were measured in 498 subjects (57±11 years; 201 male). Exercise-induced PH was defined as present if PASP ≥50 mm Hg at 50 W of exercise, and an increase in LV filling pressure during exercise was present if E/Ea ≥15 at 50 W. MAIN OUTCOME MEASURES: A combination of major cardiovascular events and any cause of death. RESULTS: During a median follow-up of 41 months, there were 14 hospitalisations and four deaths. Subjects with exercise-induced PH had significantly worse clinical outcomes than those without (p=0.014). Subjects with exercise-induced PH associated with an increase in E/Ea during exercise had significantly worse outcomes than other groups (p<0.001). However, prognosis was similar between subjects with exercise-induced PH without an increase in E/Ea and those without exercise-induced PH. In subjects with exercise-induced PH, E/Ea at 50 W was an independent predictor of adverse outcomes (HR 1.37; 95% CI 1.02 to 1.83; p=0.036). CONCLUSIONS: Exercise-induced PH provides prognostic information in subjects with preserved LV ejection fraction. The excess risk of exercise-induced PH is restricted to subjects with an increase in estimated LV filling pressure during exercise.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/93663
DOI
10.1136/hrt.2010.220467
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Internal Medicine
Yonsei Authors
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Link
 http://heart.bmj.com/content/97/17/1417.long
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