Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 Nov 18;118(21):2183-9.
doi: 10.1161/CIRCULATIONAHA.108.787101. Epub 2008 Nov 3.

Exercise-induced pulmonary arterial hypertension

James J Tolle  1 , Aaron B Waxman, Teresa L Van Horn, Paul P Pappagianopoulos, David M Systrom
Affiliations

Exercise-induced pulmonary arterial hypertension

James J Tolle et al. Circulation. .

Abstract

Background: The clinical relevance of exercise-induced pulmonary arterial hypertension (PAH) is uncertain, and its existence has never been well studied by direct measurements of central hemodynamics. Using invasive cardiopulmonary exercise testing, we hypothesized that exercise-induced PAH represents a symptomatic stage of PAH, physiologically intermediate between resting pulmonary arterial hypertension and normal.

Methods and results: A total of 406 consecutive clinically indicated cardiopulmonary exercise tests with radial and pulmonary arterial catheters and radionuclide ventriculographic scanning were analyzed. The invasive hemodynamic phenotype of exercise-induced PAH (n=78) was compared with resting PAH (n=15) and normals (n=16). Log-log plots of mean pulmonary artery pressure versus oxygen uptake (V(.)o(2)) were obtained, and a "join-point" for a least residual sum of squares for 2 straight-line segments (slopes m1, m2) was determined; m2<m1="plateau," and m2>m1="takeoff" pattern. At maximum exercise, V(.)o(2) (55.8+/-20.3% versus 66.5+/-16.3% versus 91.7+/-13.7% predicted) was lowest in resting PAH, intermediate in exercise-induced PAH, and highest in normals, whereas mean pulmonary artery pressure (48.4+/-11.1 versus 36.6+/-5.7 versus 27.4+3.7 mm Hg) and pulmonary vascular resistance (294+/-158 versus 161+/-60 versus 62+/-20 dyne x s x cm(-5), respectively; P<0.05) followed an opposite pattern. An exercise-induced PAH plateau (n=32) was associated with lower o(2)max (60.6+/-15.1% versus 72.0+/-16.1% predicted) and maximum cardiac output (78.2+/-17.1% versus 87.8+/-18.3% predicted) and a higher resting pulmonary vascular resistance (247+/-101 versus 199+/-56 dyne x s x cm(-5); P<0.05) than takeoff (n=40). The plateau pattern was most common in resting PAH, and the takeoff pattern was present in nearly all normals.

Conclusions: Exercise-induced PAH is an early, mild, and clinically relevant phase of the PAH spectrum.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures Dr. Waxman has received other research support from Gilead Pharmaceuticals and Epix Pharmaceuticals. He has also served on speakers' bureaus and consultant/advisory boards for Gilead Pharmaceuticals and United Therapeutics. Drs. Tolle and Systrom, and Ms. Van Horn and Mr. Pappagianopoulos, have no disclosures.

Figures

Figure 1
Figure 1
CPET diagnoses. PVH: pulmonary venous hypertension; PAH: pulmonary arterial hypertension
Figure 2
Figure 2
Representative plateau pattern of log-log plot of mPAP vs. VO2 in EIPAH.
Figure 3
Figure 3
Representative takeoff pattern of log-log plot of mPAP vs. VO2 in EIPAH.
Figure 4
Figure 4
mPAP takeoff vs. ventilatory threshold, p < 0.05, r = 0.52
See this image and copyright information in PMC

Comment in

References

    1. Rich S, Dantzker DR, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, Fishman AP, Goldring RM, Groves BM, Koerner SK, Levy PC, Reid LM, Vreim CE, Williams GW. Primary pulmonary hypertension. A national prospective study. Ann Intern Med. 1987;107:216–223. - PubMed
    1. Proudman SM, Stevens WM, Sahhar J, Celermajer D. Pulmonary arterial hypertension in systemic sclerosis: the need for early detection and treatment. Intern Med J. 2007;37:485–494. - PubMed
    1. Raeside DA, Chalmers G, Clelland J, Madhok R, Peacock AJ. Pulmonary artery pressure variation in patients with connective tissue disease: 24 hour ambulatory pulmonary artery pressure monitoring. Thorax. 1998;53:857–862. - PMC - PubMed
    1. McGoon M, Gutterman D, Steen V, Barst R, McCrory DC, Fortin TA, Loyd JE. Screening, early detection, and diagnosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest. 2004;126(1suppl):14S–34S. - PubMed
    1. Grunig E, Janssen B, Mereles D, Barth U, Borst MM, Vogt IR, Fischer C, Olschewski H, Kuecherer HF, Kubler W. Abnormal pulmonary artery pressure response in asymptomatic carriers of primary pulmonary hypertension gene. Circulation. 2000;102:1145–1150. - PubMed

Publication types