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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
https://ir.ymlib.yonsei.ac.kr/handle/22282913/93663
DOI
10.1136/hrt.2010.220467
Appears in Collections:
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)
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Full Text
http://heart.bmj.com/content/97/17/1417.long
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