Pulmonary arterial wedge pressure increase during exercise in patients diagnosed with pulmonary arterial or chronic thromboembolic pulmonary hypertension

Julian Müller; Laura Mayer; Simon R Schneider; Anna Titz; Esther I Schwarz; Stephanie Saxer; Michael Furian; Ekkehard Grünig; Silvia Ulrich; Mona Lichtblau

doi:10.1183/23120541.00379-2023

Pulmonary arterial wedge pressure increase during exercise in patients diagnosed with pulmonary arterial or chronic thromboembolic pulmonary hypertension

ERJ Open Res. 2023 Sep 25;9(5):00379-2023. doi: 10.1183/23120541.00379-2023. eCollection 2023 Sep.

Authors

Julian Müller^{1

2}, Laura Mayer^{1

2}, Simon R Schneider^{1

2}, Anna Titz^{1

2}, Esther I Schwarz^{1

2}, Stephanie Saxer^{1

2}, Michael Furian^{1

2}, Ekkehard Grünig³, Silvia Ulrich^{1

2

4}, Mona Lichtblau^{1

2

4}

Affiliations

¹ Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
² University of Zurich, Zurich, Switzerland.
³ Thoraxclinic Heidelberg, Heidelberg, Germany.
⁴ These authors contributed equally.

Abstract

Background: The course of pulmonary arterial wedge pressure (PAWP) during exercise in patients with pulmonary arterial or chronic thromboembolic pulmonary hypertension (PAH/CTEPH), further abbreviated as pulmonary vascular disease (PVD), is still unknown. The aim of the study was to describe PAWP during exercise in patients with PVD.

Methods: In this cross-sectional study, right heart catheter (RHC) data including PAWP, recorded during semi-supine, stepwise cycle exercise in patients with PVD, were analysed retrospectively. We investigated PAWP changes during exercise until end-exercise.

Results: In 121 patients (59 female, 66 CTEPH, 55 PAH, 62±17 years) resting PAWP was 10.2±4.1 mmHg. Corresponding peak changes in PAWP during exercise were +2.9 mmHg (95% CI 2.1-3.7 mmHg, p<0.001). Patients ≥50 years had a significantly higher increase in PAWP during exercise compared with those <50 years (p<0.001). The PAWP/cardiac output (CO) slopes were 3.9 WU for all patients, and 1.6 WU for patients <50 years and 4.5 WU for those ≥50 years.

Conclusion: In patients with PVD, PAWP increased slightly but significantly with the onset of exercise compared to resting values. The increase in PAWP during exercise was age-dependent, with patients ≥50 years showing a rapid PAWP increase even with minimal exercise. PAWP/CO slopes >2 WU are common in patients with PVD aged ≥50 years without exceeding the PAWP of 25 mmHg during exercise.