1. Role of Exercise Hemodynamics in the Prediction of Pulmonary Arterial Hypertension in BMPR2 Mutation Carriers.
- Author
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Gerges, Christian, Beurnier, Antoine, Jaïs, Xavier, Hervé, Philippe, Lau, Edmund M.T., Girerd, Barbara, Günther, Sven, Bouchachi, Amir, Jevnikar, Mitja, Boucly, Athénaïs, Bogaard, Harm Jan, Simonneau, Gérald, Sitbon, Olivier, Savale, Laurent, Chemla, Denis, Humbert, Marc, and Montani, David
- Subjects
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BONE morphogenetic protein receptors , *PULMONARY arterial hypertension , *RECEIVER operating characteristic curves , *PULMONARY hypertension , *EARLY diagnosis - Abstract
Exercise hemodynamics are recommended for early detection of pulmonary arterial hypertension (PAH) and have been suggested to be predictive of future development of PAH in high-risk populations such as BMPR2 mutation carriers. However, the optimal exercise hemodynamic screening parameter remains to be determined. Recent data suggest that pulmonary vascular distensibility (α) may serve as a useful parameter for early detection of PAH. What is the value of exercise hemodynamics, including α, for predicting the occurrence of PAH during long-term follow-up in BMPR2 mutation carriers? Fifty-two asymptomatic BMPR2 mutation carriers who underwent symptom-limited exercise hemodynamic assessment were followed up for a median of 10 years. The impact of hemodynamics at rest and exercise, presence of exercise pulmonary hypertension, and α on occurrence of PAH during long-term follow-up were assessed. During long-term follow-up, five patients developed PAH. Patients who developed PAH showed a significantly lower α (0.8 ± 0.4%/mm Hg) than patients without PAH (1.8 ± 0.8%/mm Hg; P =.008). The only hemodynamic parameter that predicted the occurrence of PAH during long-term follow-up at regression analysis was α. Receiver operating characteristic analysis showed that α ≤ 1.5%/mm Hg predicted PAH occurrence with a specificity of 75% and sensitivity of 100%. The results of this study indicate that before development of PAH in BMPR2 mutation carriers, α is reduced markedly and may serve as a useful parameter in the setting of early disease detection. Given the low event rate, caution is warranted in interpreting these results, highlighting the need for validation studies. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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