Exercise-Induced Pulmonary Hypertension: Translating Pathophysiological Concepts Into Clinical Practice

Robert Naeije, Rajeev Saggar, David Badesch, Sanjay Rajagopalan, Luna Gargani, Franz Rischard, Francesco Ferrara, Alberto M. Marra, Michele D’ Alto, Todd M. Bull, Rajan Saggar, Ekkehard Grünig, Eduardo Bossone

Research output: Contribution to journalArticlepeer-review

48 Scopus citations

Abstract

Exercise stress testing of the pulmonary circulation for the diagnosis of latent or early-stage pulmonary hypertension (PH) is gaining acceptance. There is emerging consensus to define exercise-induced PH by a mean pulmonary artery pressure > 30 mm Hg at a cardiac output < 10 L/min and a total pulmonary vascular resistance> 3 Wood units at maximum exercise, in the absence of PH at rest. Exercise-induced PH has been reported in association with a bone morphogenetic receptor-2 gene mutation, in systemic sclerosis, in left heart conditions, in chronic lung diseases, and in chronic pulmonary thromboembolism. Exercise-induced PH is a cause of decreased exercise capacity, may precede the development of manifest PH in a proportion of patients, and is associated with a decreased life expectancy. Exercise stress testing of the pulmonary circulation has to be dynamic and rely on measurements of the components of the pulmonary vascular equation during, not after exercise. Noninvasive imaging measurements may be sufficiently accurate in experienced hands, but suffer from lack of precision, so that invasive measurements are required for individual decision-making. Exercise-induced PH is caused either by pulmonary vasoconstriction, pulmonary vascular remodeling, or by increased upstream transmission of pulmonary venous pressure. This differential diagnosis is clinical. Left heart disease as a cause of exercise-induced PH can be further ascertained by a pulmonary artery wedge pressure above or below 20 mm Hg at a cardiac output < 10 L/min or a pulmonary artery wedge pressure-flow relationship above or below 2 mm Hg/L/min during exercise.

Original languageEnglish (US)
Pages (from-to)10-15
Number of pages6
JournalCHEST
Volume154
Issue number1
DOIs
StatePublished - Jul 2018

Keywords

  • exercise-induced pulmonary hypertension
  • pathophysiology
  • survival

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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