Resting pulmonary artery pressure of 21-24 mmHg predicts abnormal exercise haemodynamics

Edmund M T Lau, Laurent Godinas, Olivier Sitbon, David Montani, Laurent Savale, Xavier Jaïs, Frederic Lador, Sven Gunther, David S. Celermajer, Gérald Simonneau, Marc Humbert, Denis Chemla, Philippe Herve

Research output: Contribution to journalArticle

Abstract

A resting mean pulmonary artery pressure (mPAP) of 21-24 mmHg is above the upper limit of normal but does not reach criteria for the diagnosis of pulmonary hypertension (PH). We sought to determine whether an mPAP of 21-24 mmHg is associated with an increased risk of developing an abnormal pulmonary vascular response during exercise. Consecutive patients (n=290) with resting mPAP <25 mmHg who underwent invasive exercise haemodynamics were analysed. Risk factors for pulmonary vascular disease or left heart disease were present in 63.4% and 43.8% of subjects. An abnormal pulmonary vascular response (or exercise PH) was defined by mPAP >30 mmHg and total pulmonary vascular resistance >3 WU at maximal exercise. Exercise PH occurred in 74 (86.0%) out of 86 versus 96 (47.1%) out of 204 in the mPAP of 21-24 mmHg and mPAP <21 mmHg groups, respectively (OR 6.9, 95% CI: 3.6-13.6; p<0.0001). Patients with mPAP of 21-24 mmHg had lower 6-min walk distance (p=0.002) and higher New York Heart Association functional class status ( p=0.03). Decreasing levels of mPAP were associated with a lower prevalence of exercise PH, which occurred in 60.3%, 38.7% and 7.7% of patients with mPAP of 17-20, 13-16 and <13 mmHg, respectively. In an at-risk population, a resting mPAP between 21-24 mmHg is closely associated with exercise PH together with worse functional capacity.

Original languageEnglish
Pages (from-to)1436-1444
Number of pages9
JournalEuropean Respiratory Journal
Volume47
Issue number5
DOIs
Publication statusPublished - 1 May 2016
Externally publishedYes

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