LAUSR

Background: Exercise pulmonary hypertension (ePH) is associated with reduced aerobic capacity and is believed to represent an early stage of pulmonary vascular disease. However, the prognostic impact of ePH is not completely understood. Objectives: To evaluate the prognostic impact of ePH in patients with unexplained exertional intolerance. Methods: 707 invasive cardiopulmonary exercise tests performed between 2011-2015 at the Brigham and Women’s Hospital due to unexplained exertional intolerance were analyzed. 27 patients with ePH and 108 patients with normal resting/exercise hemodynamics (non-PH) were identified. ePH was defined by age-specific exercise pulmonary hemodynamic criteria. All-cause mortality and all-cause hospitalization rates were accessed. Results: Median follow-up was 758 days [IQR 479-1,107 days]. Mean age was 56±18 years for ePH and 56±14 years for non-PH (p=0.969). During the study period, death was reported in only 2 patients (1.5%): one with ePH (3.7%) and one with non-PH (0.9%). Inpatient hospitalization occurred in 20 patients (14.8%): seven with ePH (25.9%) and 13 with non-PH (12.0%). The Kaplan-Meier analysis of the probability of all-cause hospitalization revealed a tendency of ePH in having more hospitalizations (log rank p value = 0.079). By cox proportional analysis, the ePH hazard ratio for all-cause hospitalization was 2.2 (95%CI 0.9-5.6, p=0.087). Conclusions: In this preliminary study, with a relatively short-term follow-up, we identified that ePH might impact patients’ prognosis. This finding suggests a potential link between early pathophysiology and long-term outcome. Further studies with extended follow-up are necessary to determine the long-term prognostic impact of ePH.