Does an mPAP/CO slope >3 mmHg·L−1·min−1 during exercise predict mortality in patients with normal or mildly elevated resting pulmonary arterial pressure?
An mPAP/CO slope >3 mmHg·L−1·min−1 during exercise is an independent predictor of mortality in patients with normal or mildly elevated resting pulmonary arterial pressure, validating the 2022 ESC/ERS PH guidelines definition of exercise pulmonary hypertension.
Background Exercise pulmonary hypertension (exercise PH) was defined by a mean pulmonary arterial pressure (mPAP)/cardiac output (CO) slope >3 mmHg·L −1 ·min −1 between rest and exercise in the 2022 ESC/ERS PH guidelines. However, large, multi-center studies on the prognostic relevance of exercise hemodynamics and its added value to resting hemodynamics are missing. Patients and Methods The PEX-NET (Pulmonary Hemodynamics during Exercise Network) registry enrolled patients who underwent clinically indicated right heart catheterizations both at rest and ergometer exercise from 23 PH-centers worldwide. In this retrospective analysis we included subjects with resting mPAP3 mmHg·L −1 ·min −1 had significantly worse survival compared to those with ≤3 mmHg·L −1 ·min −1 (p=0.013; HR: 2.04 (95%CI:1.16–3.58)). Conclusion The mPAP/CO slope is a robust and independent predictor of prognosis in patients with normal or mildly elevated resting pulmonary arterial pressure that provides prognostic information beyond resting hemodynamics and appears suitable to define exercise PH.
Kovács et al. (Wed,) studied this question.