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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

 Chi Young Shim  ;  Sung-Ai Kim  ;  Donghoon Choi  ;  Woo-In Yang  ;  Jin-Mi Kim  ;  Sun-Ha Moon  ;  Hyun-Jin Lee  ;  Sungha Park  ;  Eui-Young Choi  ;  Namsik Chung  ;  Jong-Won Ha 
 Heart, Vol.97(17) : 1417-1424, 2011 
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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.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
김성애(Kim, Sung Ai)
박성하(Park, Sung Ha)
심지영(Shim, Chi Young)
양우인(Yang, Woo In)
정남식(Chung, Nam Sik)
최동훈(Choi, Dong Hoon)
최의영(Choi, Eui Young)
하종원(Ha, Jong Won) ORCID logo https://orcid.org/0000-0002-8260-2958
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