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

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.