Prognostic relevance of exercise pulmonary hypertension: results of the multicentre PEX-NET Clinical Research Collaboration.
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Kovacs Gabor, Humbert Marc, Avian Alexander, Lewis Gregory D, Ulrich Silvia, Vonk Noordegraaf Anton, Souza Rogerio, Galiè Nazzareno, Malhotra Rajeev, Saxer Stephanie, Grünig Ekkehard, Egenlauf Benjamin, Ewert Ralf, Heine Alexander, Tedford Ryan J, Houston Brian A, Kasperowicz Krzysztof, Kurzyna Marcin, Rosenkranz Stephan, Herkenrath Simon, Barbera Joan Albert, Blanco Isabel, Oliveira Rudolf K F, Andersen Mads, Savale Laurent, Systrom David, Maron Bradley A, Tello Khodr, Condliffe Robin, Mak Susanna, Baratto Claudia, Hsu Steven, D'Alto Michele, McCabe Colm, Herve Philippe, Olschewski Horst, PEX-NET (Pulmonary Haemodynamics during Exercise Network) ERS Clinical Research Collaboration
Аннотация
PATIENTS AND METHODS: The PEX-NET (Pulmonary Haemodynamics during Exercise Network) registry enrolled patients who underwent clinically indicated right heart catheterisations both at rest and ergometer exercise from 23 PH centres worldwide. In this retrospective analysis we included subjects with resting mPAP <25 mmHg and complete haemodynamic data at rest and exercise in the same body position. Mixed effects Cox proportional hazard models with random effect centre were applied to identify independent markers of prognosis among the haemodynamic parameters.
RESULTS: We included 764 patients (64% females; median (interquartile range) age 59 (46-69) years and mPAP 17 (14-20) mmHg). Median (range) observation time was 6.8 (0.1-15.9) years and 87 patients (11%) died during follow-up. After adjustment for age, sex, haemoglobin level and resting haemodynamics, CO (hazard ratio (HR) 0.85, 95% CI 0.77-0.93; p=0.001) and transpulmonary gradient (HR 1.04, 95% CI 1.00-1.08; p=0.044) at peak exercise and the mPAP/CO slope (HR 1.12, 95% CI 1.06-1.18; p<0.001) were the only independent predictors of prognosis. Patients with a mPAP/CO slope >3 mmHg·min·L-1 had significantly worse survival compared to those with a mPAP/CO slope ≤3 mmHg·min·L-1 (HR 2.04, 95% CI 1.16-3.58; p=0.013).
CONCLUSION: The mPAP/CO slope is a robust and independent predictor of prognosis in patients with normal or mildly elevated resting PAP that provides prognostic information beyond resting haemodynamics and appears suitable to define exercise PH.