Pressure-flow during exercise catheterization predicts survival in pulmonary hypertension

Background

Pulmonary hypertension manifests with impaired exercise capacity. Our aim was to investigate whether mean pulmonary arterial pressure to cardiac output relationship (mPAP/CO) predict transplant-free survival in pulmonary arterial and inoperable chronic thromboembolic pulmonary hypertension (PAH and CTEPH).

Methods

Hemodynamic data by right heart catheter in PAH and CTEPH patients at rest and during supine incremental cycle exercise were analyzed. Transplant-free-survival and predictive value of hemodynamics were assessed by Kaplan-Meier and Cox-regression-analysis.

Results

70 patients (43 female, 54 PAH, 16 CTEPH; median (quartiles) age 65(50;73) years, mPAP 34(29;44) mmHg, cardiac index (CI) 2.8(2.3;3.5) (l/min)/m2 were followed 610(251;1256) days. 1, 3, 5, 7-year survival was 89, 80, 71, 59 %. Age, WHO-functional class, 6-minute-walk distance and mixed-venous SO2 but not resting hemodynamics predicted transplant-free-survival. Maximal workload (hazard ratio, 95%-CI; p-value: 0.94(0.89-0.99); 0.027), peak and change in CI (0.51(0.27-0.95);0.034 and 0.25(0.06-0.94); 0.040) and mPAP/CO (1.02(1.01-1.03); 0.003) during exercise predicted survival. mPAP/CO predicted 3-year transplant-free-survival with an area under the curve of 0.802 (95%-CI: 0.66-0.95, p=0.004).

Conclusions

In this collective of patients with PAH or CTEPH, pressure-flow-relationship during exercise predicted transplant-free-survival and correlated with established markers of disease severity and prognosis. Exercise right heart catheterization may provide important complementary prognostic information in the management of PH.

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