Cardiopulmonary exercise testing as a diagnostic tool for the detection of left-sided pulmonary hypertension in heart failure.

Marco Guazzi, Lawrence P. Cahalin, Ross Arena

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Abstract

Recently, it has become increasingly recognized that pulmonary hypertension (PH) is a particularly ominous consequence of left-sided heart failure (HF). The primary aim of this investigation was to assess the ability of key cardiopulmonary exercise testing (CPX) variables to detect elevated pulmonary pressures in a HF cohort. This was a retrospective analysis of a prospectively collected database. Two hundred ninety-three subjects with HF (63 ± 10 years old, 79% male) underwent Doppler echocardiography to estimate resting pulmonary artery systolic pressure (PASP). Peak oxygen consumption (VO2), the minute ventilation/carbon dioxide production (VE/VCO2) slope, peak partial pressure of end-tidal CO2 (PETCO2) and exercise oscillatory ventilation (EOV) were determined. Forty-six percent (n = 134) of the subjects presented with a PASP ≥ 40 mm Hg. A VE/VCO2 slope </≥ 36.0 was the best predictor of a PASP ≥ 40 mm Hg (odds ratio [OR] 12.1, 95% confidence interval [CI] 6.8-21.4; P < .001). Peak PETCO2 ≤ 34 mm Hg (OR 3.8, 95% CI 1.3-11.2; P < .001) and the presence of EOV (OR 3.2, 95% CI 1.8-5.8; P < .001) added significant diagnostic value. Although CPX is an established prognostic assessment in the HF population, the results of the present investigation indicate that it may also have important diagnostic utility for PH.

Original languageEnglish (US)
Pages (from-to)461-467
Number of pages7
JournalJournal of cardiac failure
Volume19
Issue number7
StatePublished - Jul 2013
Externally publishedYes

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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