Potential Role of Cardiopulmonary Exercise Testing As an Early Screening Tool for Patients With Suspected Pulmonary Hypertension Including Exercise-Induced Pulmonary Hypertension: Results From a Retrospective Analysis

Objective: The primary goal of our retrospective case-control study was to evaluate the ability of cardiopulmonary exercise testing to screen for underlying exercise-induced pulmonary hypertension (EIPH) in symptomatic patients who had a negative stress test and elevated right ventricular systolic pressure on echocardiogram. We also evaluated long-acting nitrates and ranolazine as medication challenges.

Setting: Performed at a single, tertiary-care medical center in the United States.

Participants: Based on the inclusion and exclusion criteria, 81 patients were included in this study. The primary outcome of the study was to measure mean pulmonary arterial pressure at rest and exertion, as well as Wasserman curves. We also recorded patient demographics and risk factors, left ventricular ejection fraction, and mean oxygen consumption. Additionally, patients were monitored symptomatically after receiving long-acting nitrates and ranolazine.

Results: A total of 61 patients had resting pulmonary arterial hypertension, and 27 had EIPH. The EIPH group had a significantly higher mean age of 71.67 years. Wasserman curves calculated from the cardiopulmonary exercise testing data revealed 3 subgroups of EIPH patients: cardiac restriction, chronotropic incompetence, and combination of both patterns. The EIPH group showed significant improvement in symptoms after receiving long-acting nitrate therapy.

Conclusions: Many patients with symptoms of angina, dyspnea, and/or fatigue on exertion with negative cardiac stress testing may have underlying pulmonary arterial hypertension, including EIPH. Therefore, these patients require adequate treatment and follow-up to prevent worsening of symptoms and pathology.