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. 2021 Jun 9:25:20.323.
doi: 10.7812/TPP/20.323.

Potential Role of Cardiopulmonary Exercise Testing as an Early Screening Tool for Patients With Suspected Pulmonary Hypertension Including Exercise-Induced Pulmonary Hypertension: Results From a Retrospective Analysis

Zulfiqar Qutrio Baloch  1 , Shabber Agha Abbas  2 , Rohan Madhu Prasad  3 , Amin M Elamin  4 , Abbas Ali  5
Affiliations

Potential Role of Cardiopulmonary Exercise Testing as an Early Screening Tool for Patients With Suspected Pulmonary Hypertension Including Exercise-Induced Pulmonary Hypertension: Results From a Retrospective Analysis

Zulfiqar Qutrio Baloch et al. Perm J. .

Abstract

Objective: The primary goal of our retrospective case-control study was to evaluate the ability of cardiopulmonary exercise testing to screen for underlying exercise-induced pulmonary hypertension (EIPH) in symptomatic patients who had a negative stress test and elevated right ventricular systolic pressure on echocardiogram. We also evaluated long-acting nitrates and ranolazine as medication challenges.

Setting: Performed at a single, tertiary-care medical center in the United States.

Participants: Based on the inclusion and exclusion criteria, 81 patients were included in this study. The primary outcome of the study was to measure mean pulmonary arterial pressure at rest and exertion, as well as Wasserman curves. We also recorded patient demographics and risk factors, left ventricular ejection fraction, and mean oxygen consumption. Additionally, patients were monitored symptomatically after receiving long-acting nitrates and ranolazine.

Results: A total of 61 patients had resting pulmonary arterial hypertension, and 27 had EIPH. The EIPH group had a significantly higher mean age of 71.67 years. Wasserman curves calculated from the cardiopulmonary exercise testing data revealed 3 subgroups of EIPH patients: cardiac restriction, chronotropic incompetence, and combination of both patterns. The EIPH group showed significant improvement in symptoms after receiving long-acting nitrate therapy.

Conclusions: Many patients with symptoms of angina, dyspnea, and/or fatigue on exertion with negative cardiac stress testing may have underlying pulmonary arterial hypertension, including EIPH. Therefore, these patients require adequate treatment and follow-up to prevent worsening of symptoms and pathology.

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Conflict of interest statement

Disclosure Statement: The author(s) have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Patient flow diagram.
Figure 2.
Figure 2.
Comparison of mean pulmonary arterial pressure (mPAP) during exercise for all groups.
Figure 3.
Figure 3.
Comparison of resting left ventricular ejection fraction (LVEF) for all groups. -Excluded 1 patient in the exercise group, 1 in World Health Organization (WHO) group 1, 4 in WHO group 2, 1 in the no-exercise group, and 3 in the none group because they failed to produce an ejection fraction (EF) estimate on their echocardiogram.
Figure 4.
Figure 4.
Comparison of maximum oxygen consumption (VO2 max) on cardiopulmonary exercise test (CPET) for those in exercise-induced pulmonary hypertension (EIPH), World Health Organization (WHO) Group 1, and WHO Group 2 pulmonary hypertension.
Figure 5.
Figure 5.
Association of increasing age with increasing ean pulmonary arterial pressure (mPAP).
See this image and copyright information in PMC

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