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Exercise ventilatory parameters for the diagnosis of reactive pulmonary hypertension in patients with heart failure.
MedLine Citation:
PMID:  24951933     Owner:  NLM     Status:  Publisher    
BACKGROUND: Reactive pulmonary hypertension (PH) in left heart disease is associated with poor prognosis. This study aimed to evaluate the diagnostic utility of exercise ventilatory parameters on cardiopulmonary exercise testing for the diagnosis of reactive PH in patients with heart failure (HF) and reduced ejection fraction.
METHODS: This was a single-centre, retrospective analysis of a prospectively collected database of 131 patients with HF who underwent in-hospital assessment for heart transplantation. Pulmonary hemodynamics was assessed by direct cardiac catheterization. Minute ventilation/carbon dioxide production (VE/VCO2) slope, partial pressure of end-tidal CO2 (ETCO2) changes on exercise, oxygen pulse, and exercise oscillatory ventilation were determined from cardiopulmonary exercise testing.
RESULTS: Sixty-one of 131 consecutive patients had reactive PH. VE/VCO2 slope (>41), change in ETCO2 on exercise (<1.2mmHg) and exercise oscillatory ventilation were independently associated with reactive PH. These 3 parameters in combination produced 3 possible diagnostic scenarios: (i) if all 3 criteria ("if all") were present, (ii) if any 2 of the 3 criteria ("2 of 3") were present and (iii) if any of the criteria ("if any") were present. The corresponding positive/negative likelihood ratios for reactive PH if all 3 criteria were present were 3.73/0.83, if 2 of the 3 criteria were present were 2.19/0.45, and if any of the 3 criteria were present were 1.75/0.11. The post-test probability increased from 46% to 76% ("if all" present) and reduced to 9% (if none of the criteria present).
CONCLUSION: Ventilatory parameters on cardiopulmonary exercise test are associated with reactive PH in patients with HF. The absence of abnormalities in these 3 ventilatory parameters can effectively exclude reactive PH in patients with HF and poor ejection fraction.
Maria Theodosiou; Hoong Sern Lim
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-6-18
Journal Detail:
Title:  Journal of cardiac failure     Volume:  -     ISSN:  1532-8414     ISO Abbreviation:  J. Card. Fail.     Publication Date:  2014 Jun 
Date Detail:
Created Date:  2014-6-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9442138     Medline TA:  J Card Fail     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
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