Exercise Testing in Patients with Pulmonary Hypertension

Abstract

Pulmonary hypertension (PH), defined by a mean pulmonary artery pressure of >20 mm Hg, often presents with non-specific symptoms such as dyspnea and exercise intolerance, making it difficult to diagnose early before the onset of right heart dysfunction. Therefore, exercise testing can be of great utility for clinicians who are evaluating patients with an unclear etiology of exercise intolerance by helping identify the underlying mechanisms of their disease. The presence of PH is associated with adverse clinical outcomes, with distinct differences and patterns in the cardiovascular and ventilatory responses to exercise across various PH phenotypes. We discuss the role of exercise-invasive hemodynamic testing, cardiopulmonary exercise testing, and exercise stress echocardiography modalities across the spectrum of PH.

Keywords: cardiopulmonary exercise testing; exercise-induced pulmonary hypertension; heart failure with preserved ejection fraction; hemodynamics; pulmonary hypertension.

Figure 1

A diagram illustrating how invasive hemodynamics add insight into the concomitant findings on gas exchange testing. Here, the added hemodynamics unmask very different diagnoses despite having the same findings on CPET alone.