Cardiopulmonary Exercise Testing as a Diagnostic Tool for the Detection of Left-sided Pulmonary Hypertension in Heart Failure

• Published in: Journal of cardiac failure Vol. 19; no. 7; pp. 461 - 467
• Main Authors: Guazzi, Marco, MD, PhD, FACC, Cahalin, Lawrence P., PhD, PT, Arena, Ross, PhD, PT, FAHA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2013
• Subjects: Aged; Cardiovascular; diagnosis; Exercise Test - methods; Female; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - physiopathology; Humans; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - epidemiology; Hypertension, Pulmonary - physiopathology; Male; Middle Aged; Prospective Studies; pulmonary hemodynamics; Retrospective Studies; Ventilatory efficacy; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - epidemiology; Ventricular Dysfunction, Left - physiopathology; Ventilatory efficacy; diagnosis; pulmonary hemodynamics
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2013.05.005

Abstract Background 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. Methods 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 (PET CO2 ) and exercise oscillatory ventilation (EOV) were determined. Results 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 PET CO2 ≤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. Conclusions 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.