Clinical characteristics and determinants of exercise-induced pulmonary hypertension in patients with preserved left ventricular ejection fraction

Eur Heart J Cardiovasc Imaging. 2017 Mar 1;18(3):276-283. doi: 10.1093/ehjci/jew199.


Aims: Recent studies have shown that exercise-induced pulmonary hypertension (EIPH) is not rare in patients with preserved left ventricular ejection fraction (LVEF). However, the determinants and clinical implication of EIPH in these patients are unclear.

Methods and results: This study included 1383 patients who were referred for exercise echocardiography to evaluate unexplained exertional dyspnoea or chest discomfort. Pulmonary artery systolic pressure (PASP) was estimated from the maximal velocity of the tricuspid regurgitant jet added to a right atrial pressure of 10 mmHg. EIPH was defined as PASP ≥50 mmHg during exercise. The EIPH group consisted of about one-third of all patients (436 patients, 31.5%). Patients with EIPH were older, more commonly male and had shorter exercise times. In resting echocardiographic findings, the patients with EIPH had worse diastolic function associated with a lower e' value (7.0 ± 2.0 vs. 7.5 ± 2.3 cm/s, P< 0.001), a longer deceleration time (238.9 ± 54.9 vs. 232.8 ± 46.0 ms, P= 0.043), and a higher E/e' ratio (10.1 ± 2.9 vs. 9.1 ± 2.7, P< 0.001) compared with those without EIPH. In multivariable analysis, age (P< 0.001), resting E/e' ratio (P< 0.001), and resting PASP (P< 0.001) were identified as independent determinants of EIPH.

Conclusion: EIPH was documented in one-third of patients with preserved LVEF. Age, resting E/e' ratio, and resting PASP were independently associated with EIPH. Therefore, EIPH should be considered as a cause of unexplained exercise intolerance in patients with preserved LVEF.

Keywords: echocardiography; exercise; pulmonary hypertension.

Publication types

  • Comparative Study

MeSH terms

  • Age Factors
  • Aged
  • Chest Pain / diagnosis
  • Chest Pain / etiology
  • Cohort Studies
  • Databases, Factual
  • Dyspnea / diagnosis
  • Dyspnea / etiology
  • Echocardiography, Stress / adverse effects*
  • Exercise Tolerance / physiology
  • Female
  • Humans
  • Hypertension, Pulmonary / diagnostic imaging*
  • Hypertension, Pulmonary / etiology
  • Hypertension, Pulmonary / physiopathology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Reference Values
  • Regression Analysis
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sex Factors
  • Stroke Volume / physiology*
  • Ventricular Function, Left / physiology*