Impact of Exercise-Induced Pulmonary Hypertension on Right Ventricular Function and on Worsening of Cardiovascular Risk in HIV Patients
Background and Aim: Exercise-induced pulmonary hypertension (ExPH) predicts clinical outcomes, such as all-cause mortality and cardiovascular (CV) hospitalizations, in patients with dyspnea on effort. We investigated its prognostic significance in human immunodeficiency virus (HIV)-affected patients...
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MDPI AG
2022-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/24/7349 |
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| author | Rosalinda Madonna Lorenzo Ridolfi Riccardo Morganti Filippo Biondi Silvia Fabiani Arianna Forniti Riccardo Iapoce Raffaele De Caterina |
| author_facet | Rosalinda Madonna Lorenzo Ridolfi Riccardo Morganti Filippo Biondi Silvia Fabiani Arianna Forniti Riccardo Iapoce Raffaele De Caterina |
| author_sort | Rosalinda Madonna |
| collection | DOAJ |
| description | Background and Aim: Exercise-induced pulmonary hypertension (ExPH) predicts clinical outcomes, such as all-cause mortality and cardiovascular (CV) hospitalizations, in patients with dyspnea on effort. We investigated its prognostic significance in human immunodeficiency virus (HIV)-affected patients. Methods: In 52 consecutive HIV patients with either low (n = 47) or intermediate probability (n = 5) of PH at rest, we evaluated—at time 0 and after 2 years—the prognostic determinants of CV risk, according to the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) Guidelines. Patients were classified with or without ExPH at stress echocardiography (ESE) and cardiopulmonary exercise test (CPET). We then related ExPH at time 0 with clinical worsening (CV risk score increase >20% after 2 years). Results: Right ventricle (RV) systolic function was significantly reduced in patients with ExPH compared to those without ExPH at CPET. This also occurred in patients with intermediate/high probability compared to those with low probability of ExPH at ESE. The former exhibited worse values of TAPSE and FAC (<i>p</i> < 0.001 and <i>p</i> = 0.01, respectively). A significantly higher proportion of patients with ExPH (CPET) or with intermediate/high probability of ExPH (ESE) had higher sPAP (<i>p</i> < 0.001), mPAP (<i>p</i> = 0.004) and higher TRV (<i>p</i> = 0.006), as well as higher right atrial area (<i>p</i> < 0.001) and indexed right atrial volume (<i>p</i> = 0.004). Total pulmonary vascular resistance (expressed by the ratio between TRV and the velocity-time integral at the level of the right ventricular outflow tract) was higher both in patients with ExPH and in those with intermediate/high probability of ExPH (<i>p</i> < 0.001). Patients with intermediate/high probability of ExPH at ESE showed a trend (<i>p</i> = 0.137) towards clinical worsening compared to those with low probability of ExPH. No patients with low probability of ExPH had a >20% increased CV risk score after 2 years. We found an association between higher NT-proBNP and the presence or intermediate/high probability of ExPH after 2 years (<i>p</i> = 0.048 at CPET, <i>p</i> = 0.033 at ESE). Conclusions: The assessment of ExPH may predict a trend of increasing CV risk score over time. If confirmed at a longer follow-up, ExPH could contribute to better risk stratification in HIV patients. |
| first_indexed | 2024-03-09T16:16:41Z |
| format | Article |
| id | doaj.art-4338a5a07ac74d3b925d05055379a541 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T16:16:41Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-4338a5a07ac74d3b925d05055379a5412023-11-24T15:44:03ZengMDPI AGJournal of Clinical Medicine2077-03832022-12-011124734910.3390/jcm11247349Impact of Exercise-Induced Pulmonary Hypertension on Right Ventricular Function and on Worsening of Cardiovascular Risk in HIV PatientsRosalinda Madonna0Lorenzo Ridolfi1Riccardo Morganti2Filippo Biondi3Silvia Fabiani4Arianna Forniti5Riccardo Iapoce6Raffaele De Caterina7Institute of Cardiology, Department of Pathology, Cardiology Division, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56124 Pisa, ItalyInstitute of Cardiology, Department of Pathology, Cardiology Division, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56124 Pisa, ItalyInstitute of Epidemiology, University of Pisa, 56124 Pisa, ItalyInstitute of Cardiology, Department of Pathology, Cardiology Division, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56124 Pisa, ItalyInfectious Disease Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56124 Pisa, ItalyInfectious Disease Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56124 Pisa, ItalyInfectious Disease Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56124 Pisa, ItalyInstitute of Cardiology, Department of Pathology, Cardiology Division, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56124 Pisa, ItalyBackground and Aim: Exercise-induced pulmonary hypertension (ExPH) predicts clinical outcomes, such as all-cause mortality and cardiovascular (CV) hospitalizations, in patients with dyspnea on effort. We investigated its prognostic significance in human immunodeficiency virus (HIV)-affected patients. Methods: In 52 consecutive HIV patients with either low (n = 47) or intermediate probability (n = 5) of PH at rest, we evaluated—at time 0 and after 2 years—the prognostic determinants of CV risk, according to the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) Guidelines. Patients were classified with or without ExPH at stress echocardiography (ESE) and cardiopulmonary exercise test (CPET). We then related ExPH at time 0 with clinical worsening (CV risk score increase >20% after 2 years). Results: Right ventricle (RV) systolic function was significantly reduced in patients with ExPH compared to those without ExPH at CPET. This also occurred in patients with intermediate/high probability compared to those with low probability of ExPH at ESE. The former exhibited worse values of TAPSE and FAC (<i>p</i> < 0.001 and <i>p</i> = 0.01, respectively). A significantly higher proportion of patients with ExPH (CPET) or with intermediate/high probability of ExPH (ESE) had higher sPAP (<i>p</i> < 0.001), mPAP (<i>p</i> = 0.004) and higher TRV (<i>p</i> = 0.006), as well as higher right atrial area (<i>p</i> < 0.001) and indexed right atrial volume (<i>p</i> = 0.004). Total pulmonary vascular resistance (expressed by the ratio between TRV and the velocity-time integral at the level of the right ventricular outflow tract) was higher both in patients with ExPH and in those with intermediate/high probability of ExPH (<i>p</i> < 0.001). Patients with intermediate/high probability of ExPH at ESE showed a trend (<i>p</i> = 0.137) towards clinical worsening compared to those with low probability of ExPH. No patients with low probability of ExPH had a >20% increased CV risk score after 2 years. We found an association between higher NT-proBNP and the presence or intermediate/high probability of ExPH after 2 years (<i>p</i> = 0.048 at CPET, <i>p</i> = 0.033 at ESE). Conclusions: The assessment of ExPH may predict a trend of increasing CV risk score over time. If confirmed at a longer follow-up, ExPH could contribute to better risk stratification in HIV patients.https://www.mdpi.com/2077-0383/11/24/7349exercise-induced pulmonary hypertensionacquired immunodeficiency syndromecardio-pulmonary exercise testechocardiographycardiovascular risk |
| spellingShingle | Rosalinda Madonna Lorenzo Ridolfi Riccardo Morganti Filippo Biondi Silvia Fabiani Arianna Forniti Riccardo Iapoce Raffaele De Caterina Impact of Exercise-Induced Pulmonary Hypertension on Right Ventricular Function and on Worsening of Cardiovascular Risk in HIV Patients Journal of Clinical Medicine exercise-induced pulmonary hypertension acquired immunodeficiency syndrome cardio-pulmonary exercise test echocardiography cardiovascular risk |
| title | Impact of Exercise-Induced Pulmonary Hypertension on Right Ventricular Function and on Worsening of Cardiovascular Risk in HIV Patients |
| title_full | Impact of Exercise-Induced Pulmonary Hypertension on Right Ventricular Function and on Worsening of Cardiovascular Risk in HIV Patients |
| title_fullStr | Impact of Exercise-Induced Pulmonary Hypertension on Right Ventricular Function and on Worsening of Cardiovascular Risk in HIV Patients |
| title_full_unstemmed | Impact of Exercise-Induced Pulmonary Hypertension on Right Ventricular Function and on Worsening of Cardiovascular Risk in HIV Patients |
| title_short | Impact of Exercise-Induced Pulmonary Hypertension on Right Ventricular Function and on Worsening of Cardiovascular Risk in HIV Patients |
| title_sort | impact of exercise induced pulmonary hypertension on right ventricular function and on worsening of cardiovascular risk in hiv patients |
| topic | exercise-induced pulmonary hypertension acquired immunodeficiency syndrome cardio-pulmonary exercise test echocardiography cardiovascular risk |
| url | https://www.mdpi.com/2077-0383/11/24/7349 |
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