Association of Exercise-Induced Pulmonary Hypertension and Echocardiographic Parameters of Cardiac Function: A Systematic Review and Meta-Analysis
11 affiliations
- 1School of Public Health, University of South China, 421001 Hengyang, Hunan, China
- 2National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, 518057 Shenzhen, Guangdong, China
- 3Department of Respiratory Medicine, China-Japan Friendship Hospital, Capital Medical University, 100029 Beijing, China
- 4Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
- 5School of Public Health, Nanjing Medical University, 211166 Nanjing, Jiangsu, China
- 6The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031, Australia
- 7Department of Rehabilitation Medicine, Shenzhen Prevention and Treatment Center for Occupational Diseases, 518020 Shenzhen, Guangdong, China
- 8Department of Rehabilitation Medicine, Peking University Shenzhen Hospital, 518036 Shenzhen, Guangdong, China
- 9Department of Rehabilitation Medicine, The 8th Affiliated Hospital, Sun Yat-Sen University, 518016 Shenzhen, Guangdong, China
- 10Chinese Academy of Medical Sciences & Peking Union Medical College, 100006 Beijing, China
- 11Clinical Research Center, Shenzhen Medical Academy of Research and Translation, 518017 Shenzhen, Guangdong, China
Abstract
Introduction:: Exercise-induced pulmonary hypertension (EIPH) is an abnormal hemodynamic response characterized by a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mmHg/L/min between rest and exercise conditions. This systematic review and meta-analysis aimed to quantitatively synthesize existing evidence and investigate the association between EIPH and echocardiographic parameters of cardiac function.
Methods:: Electronic databases were searched through April 2025 for observational studies comparing cardiac function in individuals with EIPH and without EIPH. A random‐effects meta‐analysis model was used to pool the mean differences (MDs) and standard errors (SEs).
Results:: A total of 18 records met the inclusion criteria and were included in the meta-analysis. Compared with non-EIPH controls, individuals with EIPH exhibited a significantly attenuated cardiac output (CO) response during exercise (MD: –1.50 L/min; 95% confidence interval (CI): –2.45 to –0.54; p < 0.001) and markedly higher pulmonary vascular resistance (PVR) (MD: 1.30 wood units (WU); p < 0.001). Regarding left ventricular (LV) diastolic function, EIPH was associated with significantly lower e′ velocities and higher E/e′ ratios, with the E/e′ difference widening from rest (MD: 1.48) to peak exercise (MD: 2.46; both p < 0.001). In contrast, resting left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) did not differ significantly between groups.
Conclusions:: EIPH represents an early pathological phenotype characterized by impaired cardiac pumping reserve and subclinical biventricular dysfunction, particularly occult LV diastolic impairment. These findings highlight EIPH as a critical window for detecting subclinical heart failure. Future research should prioritize investigation into disease progression in individuals with EIPH and evaluate whether early intervention can prevent progression to overt cardiovascular failure.
The PROSPERO Registration:: CRD42024506532, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024506532.
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BibTeX
@article{chen2026association,
title = {{Association of Exercise-Induced Pulmonary Hypertension and Echocardiographic Parameters of Cardiac Function: A Systematic Review and Meta-Analysis}},
author = {Xianrui Chen and Xiaoying Liu and Jian Wang and Qian Gao and Xinying Li and Wei Wang and Yishu Liu and Menglu Ouyang and Lin Huang and Bo Hu and Hui Yu and Chuting Wang and Yu Shi and Zhihui Wang and Guiyuan Han and Shuidong Feng and Yichong Li and Ke Peng},
journal = {Reviews in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.31083/rcm51027},
url = {https://doi.org/10.31083/rcm51027},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association of Exercise-Induced Pulmonary Hypertension and Echocardiographic Parameters of Cardiac Function: A Systematic Review and Meta-Analysis
AU - Xianrui Chen
AU - Xiaoying Liu
AU - Jian Wang
AU - Qian Gao
AU - Xinying Li
AU - Wei Wang
AU - Yishu Liu
AU - Menglu Ouyang
AU - Lin Huang
AU - Bo Hu
AU - Hui Yu
AU - Chuting Wang
AU - Yu Shi
AU - Zhihui Wang
AU - Guiyuan Han
AU - Shuidong Feng
AU - Yichong Li
AU - Ke Peng
PY - 2026
DA - 2026/10/20
JO - Reviews in Cardiovascular Medicine
DO - 10.31083/rcm51027
UR - https://doi.org/10.31083/rcm51027
AB - Introduction:: Exercise-induced pulmonary hypertension (EIPH) is an abnormal hemodynamic response characterized by a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mmHg/L/min between rest and exercise conditions. This systematic review and meta-analysis aimed to quantitatively synthesize existing evidence and investigate the association between EIPH and echocardiographic parameters of cardiac function. Methods:: Electronic databases were searched through April 2025 for observational studies comparing cardiac function in individuals with EIPH and without EIPH. A random‐effects meta‐analysis model was used to pool the mean differences (MDs) and standard errors (SEs). Results:: A total of 18 records met the inclusion criteria and were included in the meta-analysis. Compared with non-EIPH controls, individuals with EIPH exhibited a significantly attenuated cardiac output (CO) response during exercise (MD: –1.50 L/min; 95% confidence interval (CI): –2.45 to –0.54; p < 0.001) and markedly higher pulmonary vascular resistance (PVR) (MD: 1.30 wood units (WU); p < 0.001). Regarding left ventricular (LV) diastolic function, EIPH was associated with significantly lower e′ velocities and higher E/e′ ratios, with the E/e′ difference widening from rest (MD: 1.48) to peak exercise (MD: 2.46; both p < 0.001). In contrast, resting left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) did not differ significantly between groups. Conclusions:: EIPH represents an early pathological phenotype characterized by impaired cardiac pumping reserve and subclinical biventricular dysfunction, particularly occult LV diastolic impairment. These findings highlight EIPH as a critical window for detecting subclinical heart failure. Future research should prioritize investigation into disease progression in individuals with EIPH and evaluate whether early intervention can prevent progression to overt cardiovascular failure. The PROSPERO Registration:: CRD42024506532, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024506532.
SN - 1530-6550
SN - 2153-8174
ER -