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Original Research: Pulmonary Vascular Disease |

Pressure-Flow During Exercise Catheterization Predicts Survival in Pulmonary Hypertension

Elisabeth D. Hasler, MD; Séverine Müller-Mottet, MD; Michael Furian, MSc ETH HMS; Stéphanie Saxer, MSc; Lars C. Huber, MD; Marco Maggiorini, MD, FCCP; Rudolf Speich, MD, FCCP; Konrad E. Bloch, MD, FCCP; Silvia Ulrich, MD
Author and Funding Information

FUNDING/SUPPORT: The work was supported by grants from the Swiss National Science Foundation and the Zurich Lung League.

aPulmonary Clinic, University Hospital Zurich, Zurich, Switzerland

bClinic of Critical Care Medicine, University Hospital Zurich, Zurich, Switzerland

cCentre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland

CORRESPONDENCE TO: Silvia Ulrich, MD, Department of Pulmonology, UniversitätsSpital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(1):57-67. doi:10.1016/j.chest.2016.02.634
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Background  Pulmonary hypertension manifests with impaired exercise capacity. Our aim was to investigate whether the mean pulmonary arterial pressure to cardiac output relationship (mPAP/CO) predicts transplant-free survival in patients with pulmonary arterial hypertension (PAH) and inoperable chronic thromboembolic pulmonary hypertension (CTEPH).

Methods  Hemodynamic data according to right heart catheterization in patients with PAH and CTEPH at rest and during supine incremental cycle exercise were analyzed. Transplant-free survival and predictive value of hemodynamics were assessed by using Kaplan-Meier and Cox regression analyses.

Results  Seventy patients (43 female; 54 with PAH, 16 with CTEPH; median (quartiles) age, 65 [50; 73] years; mPAP, 34 [29; 44] mm Hg; cardiac index, 2.8 [2.3; 3.5] [L/min]/m2) were followed up for 610 (251; 1256) days. Survival at 1, 3, 5, and 7 years was 89%, 81%, 71%, and 59%. Age, World Health Organization-functional class, 6-min walk test, and mixed-venous oxygen saturation (but not resting hemodynamics) predicted transplant-free survival. Maximal workload (hazard ratio [HR], 0.94 [95% CI, 0.89-0.99]; P = .027), peak cardiac index (HR, 0.51 [95% CI, 0.27-0.95]; P = .034), change in cardiac index, 0.25 [95% CI, 0.06-0.94]; P = .040), and mPAP/CO (HR, 1.02 [95% CI, 1.01-1.03]; P = .003) during exercise predicted survival. Values for mPAP/CO predicted 3-year transplant-free survival with an area under the curve of 0.802 (95% CI, 0.66-0.95; P = .004).

Conclusions  In this collective of patients with PAH or CTEPH, the pressure-flow relationship during exercise predicted transplant-free survival and correlated with established markers of disease severity and outcome. Right heart catheterization during exercise may provide important complementary prognostic information in the management of pulmonary hypertension.

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