Key result
A non-invasive combinatorial model predicted exercise pulmonary hypertension, with valvular dysfunction increasing the odds of exPH by 3.6-fold and a 1 L loss in vital capacity increasing the odds by 2.1-fold.
Why the study?
Existing definitions of exercise pulmonary hypertension carry a considerable risk of false positives in elderly patients with lower cardiac output during exercise.
Does a non-invasive combinatorial model using vital capacity and valvular dysfunction accurately predict exercise pulmonary hypertension in elderly patients with unclear dyspnea?
Cross-Sectional (n=244)
No
Does a non-invasive combinatorial model using vital capacity and valvular dysfunction accurately predict exercise pulmonary hypertension in elderly patients with unclear dyspnea?
A new non-invasive combinatorial model using vital capacity and valvular dysfunction offers a sensitive screening tool for predicting exercise pulmonary hypertension in elderly patients.
May inform non-invasive exPH risk assessment; leaves open prospective validation before clinical use.
Introduction: Exercise pulmonary hypertension (exPH) has been defined as total pulmonary resistance (TPR) >3 mm Hg/L/min and mean pulmonary artery pressure (mPAP) >30 mm Hg, albeit with a considerable risk of false positives in elderly patients with lower cardiac output during exercise. Methods:We retrospectively analysed patients with unclear dyspnea receiving right heart catheterisation at rest and exercise (n=244) between January 2015 and January 2020. Lung function testing, blood gas analysis, and echocardiography were performed. We elaborated a combinatorial score to advance the current definition of exPH in an elderly population (mean age 67.0 years±11.9). A stepwise regression model was calculated to non-invasively predict exPH. Results: Analysis of variables across the achieved peak power allowed the creation of a model for defining exPH, where three out of four criteria needed to be fulfilled: Peak power ≤100 Watt, pulmonary capillary wedge pressure ≥18 mm Hg, pulmonary vascular resistance >3 Wood Units, and mPAP ≥35 mm Hg. The new scoring model resulted in a lower number of exPH diagnoses than the current suggestion (63.1% vs. 78.3%). We present a combinatorial model with vital capacity (VCmax) and valvular dysfunction to predict exPH (sensitivity 93.2%; specificity 44.2%, area under the curve 0.73) based on our suggested criteria. The odds of the presence of exPH were 2.1 for a 1 l loss in VCmax and 3.6 for having valvular dysfunction. Conclusion: We advance a revised definition of exPH in elderly patients in order to overcome current limitations. We establish a new non-invasive approach to predict exPH by assessing VCmax and valvular dysfunction for early risk stratification in elderly patients.
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Wernhart et al. (2021) conducted a cross-sectional in Unclear dyspnea (Exercise pulmonary hypertension) (n=244). Valvular dysfunction and vital capacity loss vs. No valvular dysfunction and normal vital capacity was evaluated on Presence of exercise pulmonary hypertension (exPH) (OR 3.6, 95% CI 1.4-10.8, p=0.012). A non-invasive combinatorial model predicted exercise pulmonary hypertension, with valvular dysfunction increasing the odds of exPH by 3.6-fold and a 1 L loss in vital capacity increasing the odds by 2.1-fold.
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