Association of Exercise-Induced Pulmonary Hypertension and Echocardiographic Parameters of Cardiac Function: A Systematic Review and Meta-Analysis

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.