Raw data: Role of cardiopulmonary exercise test in the prediction of hemodynamic impairment in patients with pulmonary arterial hypertension

Periodic repetition of right heart catheterization (RHC) in pulmonary arterial hypertension (PAH) can be challenging. We evaluated the correlation between RHC and cardiopulmonary exercise test (CPET) aiming at CPET use as a potential noninvasive tool for hemodynamic burden evaluation. One hundred and forty‐four retrospective PAH patients who had performed CPET and RHC within 2 months were enrolled. The following analyses were performed: (a) CPET parameters in hemodynamic variables tertiles; (b) position of hemodynamic parameters in the peak end‐tidal carbon dioxide pressure (PETCO2) versus ventilation/carbon dioxide output (VE/VCO2) slope scatterplot, which is a specific hallmark of exercise respiratory abnormalities in PAH; (c) association between CPET and a hemodynamic burden score developed including mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), cardiac index, and right atrial pressure. VE/VCO2 slope and peak PETCO2 significantly varied in mPAP and PVR tertiles, while peak oxygen uptake (peak VO2) and O2 pulse varied in the tertiles of all hemodynamic parameters. PETCO2 versus VE/VCO2 slope showed a strong hyperbolic relationship (R 2 =&thinsp;0.7627). Patients with peak PETCO2 > median (26 mmHg) and VE/VCO2 slope < median (44) presented lower mPAP and PVR (p < 0.005) than patients with peak PETCO2 < median and VE/VCO2 slope > median. Multivariate analysis individuated peak VO2 (p =&thinsp;0.0158) and peak PETCO2 (p =&thinsp;0.0089) as hemodynamic score independent predictors; the formula 11.584 − 0.0925 × peak VO2 − 0.0811 × peak PETCO2 best predicts the hemodynamic score value from CPET data. A significant correlation was found between estimated and calculated scores (p < 0.0001), with a precise match for patients with mild‐to‐moderate hemodynamic burden (76% of cases). The results of the present study suggest that CPET could allow to estimate the hemodynamic burden in PAH patients.

肺动脉高压（pulmonary arterial hypertension, PAH）患者重复行右心导管术（right heart catheterization, RHC）常面临诸多挑战。本研究旨在评估RHC与心肺运动试验（cardiopulmonary exercise test, CPET）的相关性，以期将CPET开发为一种潜在的无创血流动力学负荷评估工具。本研究纳入144例在2个月内同时完成CPET与RHC的回顾性PAH患者，并开展了以下分析：（a）按血流动力学变量三分位分组分析CPET参数；（b）在峰值潮气末二氧化碳分压（peak end-tidal carbon dioxide pressure, PETCO2）与通气/二氧化碳产出（ventilation/carbon dioxide output, VE/VCO2）斜率散点图中定位血流动力学参数的分布位置——该散点图是PAH患者运动性呼吸异常的特异性特征；（c）分析CPET参数与血流动力学负荷评分的相关性，该评分纳入了平均肺动脉压（mean pulmonary arterial pressure, mPAP）、肺血管阻力（pulmonary vascular resistance, PVR）、心脏指数及右心房压。VE/VCO2斜率与峰值PETCO2在mPAP及PVR的三分位分组中存在显著差异，而峰值摄氧量（peak oxygen uptake, peak VO2）与O2脉冲则在所有血流动力学参数的三分位分组中均存在差异。PETCO2与VE/VCO2斜率呈显著双曲线相关关系（R²=0.7627）。与峰值PETCO2<中位数（26mmHg）且VE/VCO2斜率>中位数（44）的患者相比，峰值PETCO2>中位数且VE/VCO2斜率<中位数的患者其mPAP及PVR水平更低（p<0.005）。多变量分析显示，峰值VO2（p=0.0158）与峰值PETCO2（p=0.0089）是血流动力学负荷评分的独立预测因子；通过公式11.584−0.0925×峰值VO2−0.0811×峰值PETCO2，可基于CPET数据最佳预测血流动力学负荷评分值。预估评分与实际计算评分间存在显著相关性（p<0.0001），在轻至中度血流动力学负荷的患者中预测匹配度可达76%。本研究结果表明，CPET可用于评估PAH患者的血流动力学负荷。