Characteristics of Cardiopulmonary Exercise Testing of Patients with Borderline Mean Pulmonary Artery Pressure.

Jiang R, Liu H, Pudasaini B, Zhang R, Xu JL, Wang L, Zhao QH, Yuan P, Guo J, He J, Gong SG, Wu C, Wu WH, Luo CJ,Qiu HL, Jing ZC, Liu JM

Clin Respir J. 2019 Jan 22. doi: 10.1111/crj.12996. [Epub ahead of print]

BACKGROUND: Pulmonary hypertension patients with mean pulmonary artery pressure
(mPAP) ≥ 25 mmHg had impaired cardiopulmonary exercise testing (CPET). Borderline
mean pulmonary pressures (boPAP; 21-24 mmHg) represents early pulmonary
vasculopathy. The CPET characteristics of boPAP is a matter of discussion. We
aimed to determine the CPET profile of such borderline hemodynamics.
METHODS: A matched case-control study was conducted on consecutive boPAP patients
at the Shanghai Pulmonary Hospital between Jan 2012 and Jan 2017. Hemodynamics,
echocardiography, the pulmonary function test (PFT) and CPET parameters were
compared between boPAP patients and normal mPAP patients which were matched 1:1
by sex and age. Conditional logistic regression analysis was performed to
determine the efficacy of CPET in detecting boPAP.
RESULTS: A total of 48 patients underwent RHC and CPET (24 Normal, 24 boPAP).
There were no differences in the demographics, echocardiography and PFT. BoPAP
patients had significantly decreased VO2 at the anaerobic threshold and peak VO2
/kg (858.4 ± 246.5 ml/min vs. 727.9 ± 228.0 ml/min, P = 0.037; 21.1 ± 6.4
mL/min/kg vs. 15.5 ± 5.6 mL/min/kg, P = 0.001, respectively). Significant
differences were not observed in ventilation efficiency. A trend of impaired
oxygen pulse and submaximal exercise tolerance were observed in boPAP patients.
Conditional logistical regression analysis revealed the risk of boPAP increased
by 2.493 (95% confident interval: 1.388 to 4.476, P = 0.002) with every 5
mL/min/kg decrease in peak VO2 /kg.
CONCLUSIONS: Patients with boPAP have a greater prevalence of exercise
intolerance, a trend of impaired oxygen pulse and submaximal exercise tolerance.