Key result
Exercise-induced pulmonary hypertension linked to ~1.5 L/min lower exercise cardiac output.
Why the study?
Exercise-induced pulmonary hypertension is an abnormal hemodynamic response to exercise, and existing evidence on its association with echocardiographic parameters of cardiac function required quantitative synthesis.
Does exercise-induced pulmonary hypertension impair echocardiographic parameters of cardiac function compared to non-EIPH controls?
Meta-Analysis (n=4,900)
Yes
Does exercise-induced pulmonary hypertension impair echocardiographic parameters of cardiac function compared to non-EIPH controls?
Answers are grounded in this paper and cite their sources.
Exercise-induced pulmonary hypertension is associated with impaired cardiac pumping reserve and occult left ventricular diastolic dysfunction, serving as an early marker for detecting subclinical heart failure.
Introduction: Exercise-induced pulmonary hypertension (EIPH) is an abnormal hemodynamic response characterized by a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mmHg/L/min between rest and exercise conditions. This systematic review and meta-analysis aimed to quantitatively synthesize existing evidence and investigate the association between EIPH and echocardiographic parameters of cardiac function. Methods: Electronic databases were searched through April 2025 for observational studies comparing cardiac function in individuals with EIPH and without EIPH. A random‐effects meta‐analysis model was used to pool the mean differences (MDs) and standard errors (SEs). Results: A total of 18 records met the inclusion criteria and were included in the meta-analysis. Compared with non-EIPH controls, individuals with EIPH exhibited a significantly attenuated cardiac output (CO) response during exercise (MD: –1.50 L/min; 95% confidence interval (CI): –2.45 to –0.54; p < 0.001) and markedly higher pulmonary vascular resistance (PVR) (MD: 1.30 wood units (WU); p < 0.001). Regarding left ventricular (LV) diastolic function, EIPH was associated with significantly lower e′ velocities and higher E/e′ ratios, with the E/e′ difference widening from rest (MD: 1.48) to peak exercise (MD: 2.46; both p < 0.001). In contrast, resting left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) did not differ significantly between groups. Conclusions: EIPH represents an early pathological phenotype characterized by impaired cardiac pumping reserve and subclinical biventricular dysfunction, particularly occult LV diastolic impairment. These findings highlight EIPH as a critical window for detecting subclinical heart failure. Future research should prioritize investigation into disease progression in individuals with EIPH and evaluate whether early intervention can prevent progression to overt cardiovascular failure. The PROSPERO Registration: CRD42024506532, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024506532.
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Chen et al. (2026) conducted a meta-analysis in Exercise-induced pulmonary hypertension (EIPH) (n=4,900). Exercise-induced pulmonary hypertension (EIPH) vs. Non-EIPH controls was evaluated on Cardiac output (CO, L/min) during exercise (MD -1.50 L/min, 95% CI -2.45 to -0.54, p=<0.001). Exercise-induced pulmonary hypertension was associated with reduced exercise cardiac output, higher PVR, and higher peak exercise E/e' ratio.
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