Journal article
Pressure-Flow During Exercise Catheterization Predicts Survival in Pulmonary Hypertension.
- Hasler ED Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland.
- Müller-Mottet S Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland.
- Furian M Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland.
- Saxer S Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland.
- Huber LC Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland.
- Maggiorini M Clinic of Critical Care Medicine, University Hospital Zurich, Zurich, Switzerland.
- Speich R Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland.
- Bloch KE Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland; Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
- Ulrich S Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland; Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland. Electronic address: silvia.ulrich@usz.ch.
- 2016-02-20
Published in:
- Chest. - 2016
chronic thromboembolic pulmonary hypertension
exercise
hemodynamics
pulmonary arterial hypertension
pulmonary hypertension
Aged
Cardiac Catheterization
Exercise Test
Exercise Tolerance
Female
Humans
Hypertension, Pulmonary
Male
Middle Aged
Predictive Value of Tests
Prognosis
Pulmonary Embolism
Survival Analysis
Switzerland
Vascular Resistance
English
BACKGROUND
Pulmonary hypertension manifests with impaired exercise capacity. Our aim was to investigate whether the mean pulmonary arterial pressure to cardiac output relationship (mPAP/CO) predicts transplant-free survival in patients with pulmonary arterial hypertension (PAH) and inoperable chronic thromboembolic pulmonary hypertension (CTEPH).
METHODS
Hemodynamic data according to right heart catheterization in patients with PAH and CTEPH at rest and during supine incremental cycle exercise were analyzed. Transplant-free survival and predictive value of hemodynamics were assessed by using Kaplan-Meier and Cox regression analyses.
RESULTS
Seventy patients (43 female; 54 with PAH, 16 with CTEPH; median (quartiles) age, 65 [50; 73] years; mPAP, 34 [29; 44] mm Hg; cardiac index, 2.8 [2.3; 3.5] [L/min]/m(2)) were followed up for 610 (251; 1256) days. Survival at 1, 3, 5, and 7 years was 89%, 81%, 71%, and 59%. Age, World Health Organization-functional class, 6-min walk test, and mixed-venous oxygen saturation (but not resting hemodynamics) predicted transplant-free survival. Maximal workload (hazard ratio [HR], 0.94 [95% CI, 0.89-0.99]; P = .027), peak cardiac index (HR, 0.51 [95% CI, 0.27-0.95]; P = .034), change in cardiac index, 0.25 [95% CI, 0.06-0.94]; P = .040), and mPAP/CO (HR, 1.02 [95% CI, 1.01-1.03]; P = .003) during exercise predicted survival. Values for mPAP/CO predicted 3-year transplant-free survival with an area under the curve of 0.802 (95% CI, 0.66-0.95; P = .004).
CONCLUSIONS
In this collective of patients with PAH or CTEPH, the pressure-flow relationship during exercise predicted transplant-free survival and correlated with established markers of disease severity and outcome. Right heart catheterization during exercise may provide important complementary prognostic information in the management of pulmonary hypertension.
Pulmonary hypertension manifests with impaired exercise capacity. Our aim was to investigate whether the mean pulmonary arterial pressure to cardiac output relationship (mPAP/CO) predicts transplant-free survival in patients with pulmonary arterial hypertension (PAH) and inoperable chronic thromboembolic pulmonary hypertension (CTEPH).
METHODS
Hemodynamic data according to right heart catheterization in patients with PAH and CTEPH at rest and during supine incremental cycle exercise were analyzed. Transplant-free survival and predictive value of hemodynamics were assessed by using Kaplan-Meier and Cox regression analyses.
RESULTS
Seventy patients (43 female; 54 with PAH, 16 with CTEPH; median (quartiles) age, 65 [50; 73] years; mPAP, 34 [29; 44] mm Hg; cardiac index, 2.8 [2.3; 3.5] [L/min]/m(2)) were followed up for 610 (251; 1256) days. Survival at 1, 3, 5, and 7 years was 89%, 81%, 71%, and 59%. Age, World Health Organization-functional class, 6-min walk test, and mixed-venous oxygen saturation (but not resting hemodynamics) predicted transplant-free survival. Maximal workload (hazard ratio [HR], 0.94 [95% CI, 0.89-0.99]; P = .027), peak cardiac index (HR, 0.51 [95% CI, 0.27-0.95]; P = .034), change in cardiac index, 0.25 [95% CI, 0.06-0.94]; P = .040), and mPAP/CO (HR, 1.02 [95% CI, 1.01-1.03]; P = .003) during exercise predicted survival. Values for mPAP/CO predicted 3-year transplant-free survival with an area under the curve of 0.802 (95% CI, 0.66-0.95; P = .004).
CONCLUSIONS
In this collective of patients with PAH or CTEPH, the pressure-flow relationship during exercise predicted transplant-free survival and correlated with established markers of disease severity and outcome. Right heart catheterization during exercise may provide important complementary prognostic information in the management of pulmonary hypertension.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.chest.2016.02.634
- PMID 26892603
- Persistent URL
- https://folia.unifr.ch/global/documents/251956
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