Exercise-induced pulmonary hypertension: rationale for correcting pressures for flow and guide to non-invasive diagnosis.

Eur Heart J Cardiovasc Imaging

Faculty of Medicine and Life Sciences/Limburg Clinical Research Centre, Hasselt University, Agoralaan, 3600 Diepenbeek, Belgium.

Published: November 2024

AI Article Synopsis

  • Exercise-induced pulmonary hypertension (exPHT) is linked to increased risks in various heart and lung diseases, with traditional definitions relying on absolute pressure cut-offs that may not accurately indicate the condition.
  • Recent research highlights the mPAP over cardiac output (CO) slope, with a value over 3 mmHg/L/min, as a more reliable diagnostic tool for exPHT and its correlation with negative health outcomes.
  • The review emphasizes the benefits of using non-invasive stress echocardiography to assess pulmonary haemodynamics during exercise and offers a practical approach for implementing the mPAP/CO slope measurement in clinical settings.

Article Abstract

Exercise-induced pulmonary hypertension (exPHT) is a haemodynamic condition linked to increased morbidity and mortality across various cardiopulmonary diseases. Traditional definitions of exPHT rely on absolute cut-offs, such as mean pulmonary artery pressure (mPAP) above 30 mmHg during exercise. However, recent research suggests that these cut-offs may not accurately reflect pathophysiological changes, leading to false positives and false negatives. Instead, the mPAP over cardiac output (CO) slope, which incorporates both pressure and flow measurements, has emerged as a more reliable indicator. A slope exceeding 3 mmHg/L/min is now considered diagnostic for exPHT and strongly correlates with adverse outcomes. Stress echocardiography serves as a viable alternative to invasive assessment, enabling broader implementation. This review discusses the physiological basis of pulmonary haemodynamics during exercise, the advantages of the mPAP/CO slope over absolute pressure measurements, the evidence supporting its inclusion in clinical guidelines, and provides a practical guide for non-invasive determining the mPAP/CO slope in clinical practice.

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http://dx.doi.org/10.1093/ehjci/jeae239DOI Listing

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