Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension

Eur J Prev Cardiol. 2014 Nov;21(11):1409-19. doi: 10.1177/2047487313494293. Epub 2013 Jun 20.


Background: Increased ventilatory (.VE) response to carbon dioxide output (.VCO2) is a key finding of incremental cardiopulmonary exercise testing in both heart failure and pulmonary arterial hypertension (PAH). As with heart failure, measures of excessive exercise ventilation considering high-to-peak exercise .VE-VCO2 might have higher prognostic relevance than those restrained to sub-maximal exercise in PAH.

Design: Cross-sectional and observational study on a tertiary center.

Methods: Eighty-four patients (36 idiopathic and 48 with associated conditions) were followed up for up to five years. Excessive exercise ventilation was calculated as a slope (Δ .VE/Δ .VCO2 to the respiratory compensation point (RCP) and to exercise cessation (PEAK)) and as a ratio (.VE-VCO2 at the anaerobic threshold (AT) and at PEAK).

Results: Thirteen patients died and three had atrial septostomy. Multivariable regression analyses revealed that Δ .VE/Δ .VCO2(PEAK) <55 and .VE/.VCO2(PEAK) <57 were better related to prognosis than Δ .VE/Δ .VCO2(RCP) and .VE/.VCO2(AT) (p < 0.01). Δ oxygen uptake (.VO2)/Δ work rate >5.5 ml/min per W was the only other independent prognostic index. According to a Kaplan-Meier survival analysis, 96.9% (90.8% to 100%) of patients showing Δ .VE/Δ .VCO2(PEAK) <55 and Δ .VO2/Δ work rate >5.5 ml/min per W were free from a PAH-related event. In contrast, 74.7% (70.1% to 78.2%) with both parameters outside these ranges had a negative outcome.

Conclusion: Measurements of excessive exercise ventilation which consider all data points maximize the usefulness of incremental cardiopulmonary exercise testing in the prognosis evaluation of PAH.

Keywords: Exertion; exercise testing; prognosis; pulmonary hypertension; ventilation.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Arterial Pressure*
  • Brazil
  • Chi-Square Distribution
  • Cross-Sectional Studies
  • Disease Progression
  • Disease-Free Survival
  • Exercise Test*
  • Female
  • Humans
  • Hypertension, Pulmonary / diagnosis*
  • Hypertension, Pulmonary / mortality
  • Hypertension, Pulmonary / physiopathology
  • Hypertension, Pulmonary / therapy
  • Kaplan-Meier Estimate
  • Lung / physiopathology*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Pulmonary Artery / physiopathology*
  • Pulmonary Ventilation*
  • Risk Factors
  • Spirometry
  • Tertiary Care Centers
  • Time Factors
  • Young Adult