Original Article | Published:

Sex-specific cardiopulmonary exercise testing parameters as predictors in patients with idiopathic pulmonary arterial hypertension

Hypertension Research volume 40, pages 868875 (05 October 2017) | Download Citation

Abstract

Cardiopulmonary exercise testing (CPET) has been used for prognosis in idiopathic pulmonary arterial hypertension (IPAH). We explored whether sex differences had an impact on prognostic assessments of CPET in IPAH. Data were retrieved from 21 male and 36 female incident IPAH patients who underwent both right heart catheterization and CPET from 2010 to 2016 at Shanghai Pulmonary Hospital. Cox proportional hazards analysis was used to assess the prognostic value of CPET. The mean duration of follow-up was 22±15 months. Nine men and 15 women had an event. The differences in clinical parameters in the whole population were not the same as the inter-subgroup differences. Event-free women had significantly higher cardiac output, lower pulmonary vascular resistance and percentage of predicted FVC compared with event men (all P<0.05). Event-free men had significantly higher end-tidal partial pressure of CO2 (PETCO2) at anaerobic threshold (AT), peak workload, PETCO2, maximum oxygen consumption (VO2)/minute ventilation (VE), and oxygen uptake efficiency slope and lower end-tidal partial pressure of O2 (PETO2) at AT, peak PETO2, and lowest VE/VCO2 compared with event men. Event-free women had dramatically higher peak VO2, VCO2, VE and O2 pulse than event women (all P<0.05). Peak PETCO2 was the independent predictor of event-free survival in all patients and males, whereas peak O2 pulse was the independent predictor of event-free survival in females. Men with peak PETCO220.50 mm Hg, women with peak O2 pulse 6.25 ml per beat and all patients with peak PETCO227.03 mm Hg had significantly better event-free survival. Sex-specific CPET parameters are predictors of poor outcomes. Decreased peak PETCO2 in men and peak O2 pulse in women were associated with lower event-free survival in IPAH.

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Acknowledgements

We thank the study investigators, fellows, nurses and research coordinators who participated in the present study. This work was supported by the Program of Shanghai Municipal Commission of Health and Family Planning (20144Y0196), the Program of Shanghai Natural Science Foundation (15ZR1434400) and the Program of National Natural Science Foundation of China (81500040).

Author contributions

J-ML and PY designed the study; PY, H-JN and T-XC contributed to drafting of the manuscript and data acquisition; PY, T-XC, RJ, HL and BP contributed to data analysis and statistical analysis; RJ, BP, Q-HZ, LW, S-GG and J-ML contributed to critical revision of the manuscript; J-ML contributed to study supervision; PY and J-ML contributed to acquisition of funding, and all authors approved the final version of the manuscript for submission.

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Author notes

    • Ping Yuan
    • , Hui-Juan Ni
    • , Tian-Xiang Chen
    •  & Bigyan Pudasaini

    These authors contributed equally to this work.

Affiliations

  1. Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China

    • Ping Yuan
    • , Tian-Xiang Chen
    • , Bigyan Pudasaini
    • , Rong Jiang
    • , Qin-Hua Zhao
    • , Lan Wang
    • , Su-Gang Gong
    •  & Jin-Ming Liu
  2. Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China

    • Hui-Juan Ni
  3. Department of Respiratory and Critical Care Medicine, Henan Provincial Peoples’ Hospital, Zhengzhou University, Zhengzhou, China

    • Hui Liu

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The authors declare no conflict of interest.

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Correspondence to Jin-Ming Liu.

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DOI

https://doi.org/10.1038/hr.2017.52