Exercise Testing to Estimate Survival in Pulmonary Hypertension

Abstract

: CPET parameters predict survival in PH patients and add marginally to the prognostic value of the 6MWD.

The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension

“…This was also demonstrable in a meta-analysis of the many treatment trials in PAH [141]. It retains significance in multivariate analyses even when other strong predictors are included such as patient demographics [127,140], baseline haemodynamics from right heart catheterisation or CMR [140,142,143], CPET variables [92,113] and presence of pericardial effusion [127]. Absolute values of 6MWD measured following PAH treatment retain prognostic power but do not improve on the baseline measurement [144].…”

Chronic Thromboembolic Pulmonary Hypertension: Effects of Pulmonary Endarterectomy

“…By contributing to the elevated pulmonary vascular resistance, this arteriopathy adversely affects cardiac function and may, in the end, contribute to the progressive hemodynamic instability and increased mortality observed in patients with CTEPH (Riedel et al, 1982). Advanced CTEPH leads to cardiac remodelling, as characterized by right ventricular (RV) dilatation and hypertrophy, tricuspid regurgitation and leftward ventricular septal bowing (LVSB), with a consequent impact on cardiac function (Fleg et al, 2000;Groepenhoff et al, 2008;Kreitner et al, 2007Kreitner et al, , 2004Reesink et al, 2007). We have shown that LVSB is present in the majority of CTEPH patients (Reesink et al, 2007).…”

Author's Reply

“…For the CPET variables reported by Trip et al, [1] we have provided the survival rates based on cut-off values from previous studies. An oxygen consumption (VO 2 ) <1.32 l/kg/min has cumulative survival rates of 71% [5] and an oxygen (O 2 ) pulse <12 ml/beat with and without cardiopulmonary disease has a relative mortality risk of 3.4 and 2.2, respectively. [6] The reported O 2 pulse of 9.1 ml/beat reported in the current study suggests greater disease severity with a higher mortality risk, which decreased with initiation of treatment, though not completely ameliorating risk.…”