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Submitted: 18 Sep 2020
Accepted: 05 Jan 2021
ePublished: 30 Jan 2021
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J Cardiovasc Thorac Res. 2021;13(1): 68-78.
doi: 10.34172/jcvtr.2021.05
  Abstract View: 67
  PDF Download: 32

Original Article

Vital capacity and valvular dysfunction could serve as non-invasive predictors to screen for exercise pulmonary hypertension in the elderly based on a new diagnostic score

Simon Wernhart 1,2* ORCID logo, Jürgen Hedderich 3, Eberhard Weihe 4

1 Department of Cardiology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, Germany
2 University Hospital Essen, University Duisburg-Essen, West German Heart- and Vascular Center, Department of Cardiology and Vascular Medicine, Hufelandstrasse 55, 45147 Essen, Germany
3 Medistat-Biomedical Statistics, Medistat GmbH, Kronshagen, Germany
4 Institute of Anatomy and Cell Biology of the Philipps-University Marburg, Germany
*Corresponding Author: Simon Wernhart, Email: simon.wernhart@gmx.de

Abstract

Introduction: Exercise pulmonary hypertension (exPH) has been defined as total pulmonary resistance (TPR) >3 mm Hg/L/min and mean pulmonary artery pressure (mPAP) >30 mm Hg, albeit with a considerable risk of false positives in elderly patients with lower cardiac output during exercise.

Methods:We retrospectively analysed patients with unclear dyspnea receiving right heart catheterisation at rest and exercise (n=244) between January 2015 and January 2020. Lung function testing, blood gas analysis, and echocardiography were performed. We elaborated a combinatorial score to advance the current definition of exPH in an elderly population (mean age 67.0 years±11.9). A stepwise regression model was calculated to non-invasively predict exPH.

Results: Analysis of variables across the achieved peak power allowed the creation of a model for defining exPH, where three out of four criteria needed to be fulfilled: Peak power ≤100 Watt, pulmonary capillary wedge pressure ≥18 mm Hg, pulmonary vascular resistance >3 Wood Units, and mPAP ≥35 mm Hg. The new scoring model resulted in a lower number of exPH diagnoses than the current suggestion (63.1% vs. 78.3%). We present a combinatorial model with vital capacity (VCmax) and valvular dysfunction to predict exPH (sensitivity 93.2%; specificity 44.2%, area under the curve 0.73) based on our suggested criteria. The odds of the presence of exPH were 2.1 for a 1 l loss in VCmax and 3.6 for having valvular dysfunction.

Conclusion: We advance a revised definition of exPH in elderly patients in order to overcome current limitations. We establish a new non-invasive approach to predict exPH by assessing VCmax and valvular dysfunction for early risk stratification in elderly patients.

Keywords: Exercise Pulmonary Hypertension, Elderly, Valvular Dysfunction, Vital Capacity
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