Ventilatory efficiency testing as prognostic value in patients with pulmonary hypertension

Area of Science:

• Cardiology
• Pulmonology
• Exercise Physiology

Background:

• Increased ventilatory response is a known prognostic marker in chronic heart failure.
• Pulmonary hypertension (PH) requires accurate prognostic indicators for patient management.

Purpose of the Study:

• To assess ventilatory efficiency using cardiopulmonary exercise testing (CPET) in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension.
• To identify PH patients at increased risk of mortality within 24 months.

Main Methods:

• 116 PH patients (mean age 64 years) underwent CPET and right heart catheterization.
• Patients were followed for 24 months, comparing characteristics of survivors and nonsurvivors.

Main Results:

• Significant differences in ventilatory equivalents for oxygen and carbon dioxide (Ve/VCO2) were observed between survivors and nonsurvivors (p ≤ 0.005).
• Specific thresholds for peak oxygen uptake, Ve/VCO2, alveolar-arterial oxygen difference, and Ve/VCO2 slope were associated with significantly increased 24-month mortality risk.

Conclusions:

• Abnormalities in exercise ventilation are powerful predictors of outcomes in PH.
• Clinical guidelines should consider adding ventilatory efficiency parameters, alongside peak VO2, for prognostic assessment in PH patients.