Exercise feature and predictor of prognosis in patients with pulmonary artery stenosis-associated pulmonary hypertension

Xin Li; Anqi Duan; Qi Jin; Yi Zhang; Qin Luo; Qing Zhao; Lu Yan; Zhihua Huang; Meixi Hu; Changming Xiong; Zhihui Zhao; Zhihong Liu

doi:10.1002/ehf2.14154

Exercise feature and predictor of prognosis in patients with pulmonary artery stenosis-associated pulmonary hypertension

ESC Heart Fail. 2022 Dec;9(6):4198-4208. doi: 10.1002/ehf2.14154. Epub 2022 Sep 13.

Authors

Xin Li¹, Anqi Duan¹, Qi Jin^{1

2}, Yi Zhang¹, Qin Luo¹, Qing Zhao¹, Lu Yan¹, Zhihua Huang¹, Meixi Hu¹, Changming Xiong¹, Zhihui Zhao¹, Zhihong Liu¹

Affiliations

¹ Center for Respiratory and Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.

Abstract

Aims: The prognosis is poor for patients with pulmonary artery stenosis-associated pulmonary hypertension (PAS-PH). Identifying predictors of prognosis in PAS-PH is crucial to preventing premature death, which has rarely been investigated. We aimed to explore the cardiopulmonary exercise testing (CPET) parameters to predict the prognosis of these patients.

Methods: We prospectively included all patients with PAS-PH who underwent CPET between September 2014 and June 2021 in Fuwai Hospital (ClinicalTrials.gov ID: NCT02061787). The primary outcome was clinical worsening, including death, rehospitalization for heart failure, or deterioration of PH.

Results: Seventy-two patients were included in this study. A median of 2-year follow-up revealed that 18 (25%) patients experienced clinical worsening. The 1-year, 3-year, and 5-year event-free survival rates were 92.5%, 81.7%, and 62.7%, respectively. Patients with clinical worsening demonstrated significantly worse baseline haemodynamics and poorer exercise capacity than their counterparts. Multivariable Cox regression identified that peak O₂ pulse could independently predict clinical worsening [hazard ratio: 0.344, 95% confidence interval (CI) 0.188-0.631, P < 0.001], outperforming other parameters. Peak O₂ pulse correlated with PH severity. Incorporating peak O₂ pulse into the simplified 2015 European Society of Cardiology/European Respiratory Society risk stratification improved the accuracy for predicting clinical worsening (pre vs. post area under the curve: 0.727 vs. 0.846, P < 0.001; net reclassification index: 0.852, 95% CI 0.372-1.332, P < 0.001; integrated discrimination index 0.133, 95% CI 0.031-0.235, P = 0.011).

Conclusions: The prognosis is poor for PAS-PH, and exercise intolerance and ventilation inefficiency are commonly observed. Peak O₂ pulse independently predicted the prognosis of these patients. A low peak O₂ pulse identified patients at high risk of clinical deterioration and served for risk stratification of PAS-PH.

Keywords: Cardiopulmonary exercise testing; Peak O2 pulse; Pulmonary artery stenosis; Pulmonary hypertension; Takayasu arteritis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Hypertension, Pulmonary* / diagnosis
Hypertension, Pulmonary* / etiology
Lung
Prognosis
Prospective Studies
Pulmonary Artery
Stenosis, Pulmonary Artery*

Associated data

ClinicalTrials.gov/NCT02061787