Cardiopulmonary exercise testing responses to treatment in patients with pulmonary arterial hypertension and cardiopulmonary comorbidities

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Introduction. Guidelines recommend initial monotherapy in PAH patients with cardiopulmonary comorbidities (Humbert et al ERJ 2023). However, data on the cardiopulmonary physiological responses to treatment in this subset of patients remain limited. Aims. To evaluate the cardiopulmonary exercise response to treatment in PAH patients with and without cardiopulmonary comorbidities. Methods. Incident treatment-naïve patients with I, H, D/T-induced, and CTD-associated PAH were analysed at first follow-up. Comorbid patients were defined based on the presence of ≥3 risk factors among BMI ≥30, hypertension, diabetes, coronary artery disease, smoking and TLCO <45%. Results. 52 patients with comorbidities and 126 without were included. Comorbid patients were older, predominantly male, and had a lower baseline exercise capacity, despite comparable hemodynamics. There were no differences in therapy, with ∼ one third of patients on combination therapy in both groups. At follow-up, both groups demonstrated similar improvements in peak VO2 and ventilatory efficiency. However, comorbid patients exhibited smaller improvements in hemodynamics, alongside a worse gas exchange response. Conclusions. PAH patients with and without cardiopulmonary comorbidities achieve similar improvements in exercise capacity. The worse gas exchange among comorbid patients warrants caution and further research. erj;66/suppl_69/PA5141/F1 F1 F1

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