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

Eur Respir J. 2016 May;47(5):1436-44. doi: 10.1183/13993003.01684-2015. Epub 2016 Mar 10.

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.

MeSH terms

  • Adult
  • Aged
  • Blood Pressure
  • Cardiac Output / physiology
  • Exercise / physiology*
  • Female
  • Hemodynamics / physiology*
  • Humans
  • Hypertension, Pulmonary / physiopathology
  • Male
  • Middle Aged
  • Phenotype
  • Pulmonary Artery / physiopathology*
  • Rest
  • Risk Factors
  • Vascular Resistance / physiology