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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.
MedLine Citation:
PMID:  21653218     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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&emsp14;years; 201 male). Exercise-induced PH was defined as present if PASP ≥50&emsp14;mm Hg at 50&emsp14;W of exercise, and an increase in LV filling pressure during exercise was present if E/Ea ≥15 at 50&emsp14;W. Main outcome measures A combination of major cardiovascular events and any cause of death. Results During a median follow-up of 41&emsp14;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&emsp14;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.
Authors:
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
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-7
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  -     ISSN:  1468-201X     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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