Aims: We investigated the course of pulmonary arterial wedge pressure (PAWP) during exercise in patients with pulmonary vascular disease (PVD) defined as pulmonary arterial or chronic thromboembolic pulmonary hypertension (PAH/CTEPH).

Methods: Right heart catheter (RHC) data including PAWP, recorded during semi-supine, stepwise cycle exercise in patients with PVD were analysed retrospectively. We investigated PAWP-changes during exercise until end-exercise.

Results: In 121 patients (49 female, 66 CTEPH, 55 PAH, 61.5 ± 16.5 years) resting PAWP was 10.2 ± 4.1 mmHg. Corresponding peak changes in PAWP during exercise were +2.9 mmHg (95% CI: 2.1 to 3.7 mmHg, p<0.001). Patients ?50 years had a significantly higher increase in PAWP during exercise compared with <50 years (p<0.001). The PAWP/CO-slopes were 3.9 WU for all patients, and 1.6 WU for patients <50 years and 4.5 WU ? 50years.

Conclusion: In patients with PVD, PAWP increased slightly but significantly with the onset of exercise compared to resting values. The increase in PAWP during exercise was age-dependent, with patients ?50 years showing a rapid PAWP increase even with minimal exercise. PAWP/CO slopes >2 WU are common in patients with PVD ?50 years without exceeding the PAWP of 25 mmHg during exercise.