The following is a summary of “Exercise Testing in the Risk Assessment of Pulmonary Hypertension,” published in the September 2023  issue of Pulmonology by Forbes, et al.

A decrease in exercise capacity, increased risk of illness and death, and right ventricular dysfunction are all associated with PH. Negative prognostic implications of right ventricular dysfunction may be revealed during exercise even if they were not present at rest. Exercising may cause a greater rise in right ventricular afterload in persons with pulmonary vascular disease than in healthy individuals. 

To maintain ventricular-arterial coupling (the link between contractility and afterload) and, by extension, cardiac output, right ventricular contractility must rise to meet the demands of increasing afterload. Because of ventricular-arterial uncoupling, which is caused by a lack of contractile reserve in the right ventricle, cardiac output does not rise with exercise. Abnormalities in the pulmonary vascular response to exercise are correlated with an increased risk of death and may be an indicator of pulmonary vascular disease at an early stage. Low levels of right ventricular contractile reserve are also predictive of poor health and early death. The pulmonary vascular response to exercise and the contractile reserve of the right ventricle may be evaluated using exercise provocation. 

Patients with suspected or confirmed PH may undergo screening, diagnosis, and risk stratification using a combination of noninvasive (such as cardiopulmonary exercise testing, transthoracic echocardiography, and cardiac MRI) and invasive (such as right heart catheterization and pressure-volume analysis) methods. Exercise stress testing may be useful in the treatment of pulmonary vascular disease, although further study is needed to verify this. Patients with suspected or confirmed PH are evaluated for risk by exercise testing, which is described in this study.

Source: sciencedirect.com/science/article/abs/pii/S0012369223005093