Cardiopulmonary exercise test predicts right heart catheterization

Eur J Clin Invest. 2017 Dec;47(12). doi: 10.1111/eci.12851. Epub 2017 Nov 17.

Abstract

Background: Right heart catheterization (RHC) is usually required to confirm the diagnosis of pulmonary artery hypertension (PAH). As an invasive test, RHC may be associated with possible complications, so noninvasive parameters able to predict PAH at RHC would be extremely useful.

Aim: To ascertain possible correlations between cardiopulmonary exercise testing (CPET) and hemodynamic parameters at RHC indicative of pulmonary hypertension (PH).

Methods: Thirty-six consecutive outpatients with suspect of PAH underwent CPET and RHC; the intercept of ventilation (VEint) on the VE vs carbon dioxide production (VE/VCO2 ) and VE/VCO2 slope at CPET and diastolic pressure gradient (DPG), trans-pulmonary pressure gradient (TPG), mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) at RHC were assessed and compared.

Results: Ventilation VCO2 slope was directly related to DPG (r: .41, P: .019), TPG (r: .45, P: .01), mean pulmonary arterial pressure (mPAP, r: .36, P: .031), PVR (r: .41, P: .029), VEint and VE/VCO2 slope inversely related to DPG (r: -.63, P < .001), TPG (r: -.67, P < .001), mPAP (r: -.68, P < .001) and PVR (r: -.5, P < .001).

Conclusion: In patients with suspected PAH, VEint during exercise and the VE/VCO2 slope might provide useful information to predict results of RHC. Their correlations with PVR and with DPG may be helpful in discriminating patients with isolated postcapillary PH from those with combined postcapillary and precapillary.

Keywords: cardiopulmonary exercise test; diastolic pressure gradient; intercept of ventilation; pulmonary vascular resistance; transpulmonary pressure gradient.

MeSH terms

  • Adult
  • Aged
  • Arterial Pressure / physiology*
  • Blood Pressure
  • Carbon Dioxide / metabolism*
  • Cardiac Catheterization
  • Cohort Studies
  • Diastole
  • Exercise Test
  • Female
  • Hemodynamics
  • Humans
  • Hypertension, Pulmonary / diagnosis*
  • Hypertension, Pulmonary / physiopathology
  • Male
  • Middle Aged
  • Oxygen Consumption
  • Pulmonary Artery / physiopathology*
  • Pulmonary Ventilation / physiology*
  • Risk Assessment
  • Vascular Resistance / physiology*

Substances

  • Carbon Dioxide