Supplementary Material for: Exercise Hemodynamics in the Prognosis of Patients with Pulmonary Arterial Hypertension

Background: Assessment of prognosis is of major importance when deciding on a therapeutic strategy in patients with pulmonary arterial hypertension (PAH). Objectives: The aim of this study was to investigate the prognostic value of pulmonary hemodynamics during exercise and changes during treatment in patients with PAH. Methods: Consecutive incident patients (n = 49) with PAH undergoing right heart catheterization at rest and during a constant workload cycle exercise in supine position were included. Predictors of survival were identified at baseline using Cox proportional hazard regression models in a univariate analysis unadjusted and adjusted for age and gender. Results: During a median follow-up period of 42 months, 13 (27%) of the 49 patients studied died. Two predictors of death were found: rest-to-exercise changes in heart rate and systolic pulmonary artery pressure. Adjusted hazard ratios were 0.92 (95% CI 0.86–0.99) and 0.93 (95% CI 0.88–0.99), respectively. These 2 variables were correlated with each other (r = 0.55, p < 0.001). Conclusions: Rest-to-exercise changes in heart rate and systolic pulmonary artery pressure measured at diagnosis are predictors of survival in patients with PAH. These measurements taken from an exercise test reflect right ventricular function.

背景：在为肺动脉高压（pulmonary arterial hypertension，PAH）患者制定治疗策略时，预后评估具有核心重要性。
研究目的：本研究旨在探讨PAH患者运动时的肺血流动力学特征及其治疗过程中的变化对预后的评估价值。
研究方法：本研究纳入49例连续新发确诊的PAH患者，所有受试者均接受静息状态及仰卧位恒定负荷循环运动下的右心导管检查。本研究通过单变量分析（未校正及校正年龄与性别因素）结合Cox比例风险回归模型，在基线水平识别生存预后的影响因素。
研究结果：中位随访时长为42个月期间，纳入研究的49例患者中有13例（27%）死亡。本研究共发现2项死亡预后影响因素：静息至运动状态下的心率变化，以及收缩期肺动脉压变化。校正后的风险比分别为0.92（95%置信区间：0.86~0.99）与0.93（95%置信区间：0.88~0.99）。这两项变量之间存在显著相关性（r=0.55，p<0.001）。
研究结论：确诊时测得的静息至运动状态下的心率变化与收缩期肺动脉压变化，可作为PAH患者生存预后的预测因素。此类运动试验所得的检测指标，可反映右心室功能状态。