European Heart Journal Advance Access originally published online on February 21, 2007
European Heart Journal 2007 28(5):569-574; doi:10.1093/eurheartj/ehl561
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Determinants of pulmonary artery hypertension at rest and during exercise in patients with heart failure
Department of Cardiology, University Hospital Sart Tilman, B-4000 LIEGE, Belgium
Received 25 August 2006; revised 16 January 2007; accepted 26 January 2007; online publish-ahead-of-print 21 February 2007.
* Corresponding author. Tel: +32 4 366 71 94; fax: +32 4 366 71 95. E-mail address: lpierard{at}chu.ulg.ac.be or plancellotti{at}chu.ulg.ac.be
Aims: Pulmonary hypertension, a marker of poor prognosis in heart failure, may develop or increase during exercise. We sought to examine the determinants of pulmonary hypertension at rest and during exercise in heart failure patients.
Methods and results: Forty-six patients with left ventricular (LV) dysfunction (ejection fraction: 30 ± 6%) underwent a semi-recumbent, incremental bicycle exercise Doppler echocardiography. LV systolic and diastolic function, pulmonary artery systolic pressure (PASP), functional mitral regurgitation (MR), and left atrial volume were quantified at rest and during exercise. Wide changes in PASP at exercise were unrelated to PASP at rest (r = 0.12). Independent predictors of PASP at rest were left atrial volume (P = 0.006), E-wave velocity (P = 0.02), mitral tenting area (P = 0.005), and mitral effective regurgitant orifice (ERO) (P = 0.02). The incidence of dyspnoea was similar in patients with and without moderately severe pulmonary hypertension at baseline. At peak exercise, LV ejection fraction (P = 0.03) and mitral ERO (P = 0.008) were independently associated with PASP. Patients with a larger exercise increase in PASP (>60 mmHg) interrupted frequently exercise for dyspnoea (70 vs. 27%; P = 0.04). A larger rise in mitral regurgitant volume during exercise emerged as the single determinant of exercise-induced increases in PASP.
Conclusion: In patients with HF, left atrial volume, mitral deformation, and mitral regurgitant orifice correlated with pulmonary pressure at rest, whereas dynamic MR and limited contractile reserve correlated with pulmonary pressure at exercise. The magnitude of pulmonary pressure during exercise in these patients mainly depends on dynamic MR.
Key Words: Heart failure • Pulmonary artery hypertension • Mitral regurgitation • Exercise
The first two authors contributed equally to this work.
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