Prognostication in Pulmonary Arterial Hypertension with Submaximal Exercise Testing

Area of Science:

• Cardiology
• Pulmonology
• Exercise Physiology

Background:

• Submaximal exercise tests (SETs) offer potential as robust functional and prognostic markers in pulmonary arterial hypertension (PAH).
• SETs may surpass the six-minute walk test (6MWT) in assessing exercise tolerance and disease severity.

Purpose of the Study:

• To determine the prognostic value of SET in PAH patients.
• To compare the prognostic capability of SET with the REVEAL registry risk score (RRRS).

Main Methods:

• Sixty-five PAH patients underwent right-heart catheterization, echocardiogram, 6MWT, and a 3-minute SET.
• Analyses correlated SET variables with prognosis predicted by the RRRS.

Main Results:

• V_E/V_CO2 emerged as an independent predictor of prognosis in multivariate analysis (β = 0.05, p = 0.0371).
• V_E/V_CO2 demonstrated high discriminatory power for identifying high-risk patients (RRRS ≥ 10) with excellent sensitivity (92%) and negative-predictive value (97%).

Conclusions:

• SETs, specifically V_E/V_CO2, possess significant prognostic value in PAH patients.
• Prospective validation could establish SET as a superior alternative to the 6MWT and RRRS in clinical trials and practice.