Background Exercise-induced pulmonary hypertension (EIPH) is common even in subjects with preserved left ventricular (LV) ejection fraction and an increase in left ventricular filling pressure (LVFP) is considered as an important contributor of EIPH. However, clinical outcome of EIPH is unknown in subjects with preserved LV ejection fraction. We hypothesized that EIPH would predict clinical outcome and which associated with increased LVFP would show poorer outcome. Methods and Results Of 1,347 consecutive subjects who were referred for diastolic stress echocardiography, 523 subjects (58 짹 11 years, 211 males) comprised study population after excluding patients with LV systolic dysfunction, cardiomyopathies, end-stage renal disease and patients whose tricuspid regurgitation velocity or E/E��� could not be measured either at rest or during exercise. EIPH was defined as present if pulmonary arterial systolic pressure���50 mmHg and an increase in LVFP during exercise was if E/E������15 at 50W of exercise. Subjects were followed for a median of 32 months. The end-point was a composite of major cardiovascular events and any cause of deaths. Patients with EIPH related with increased LVFP showed poorer outcome than those with normal LVFP or patients without EIPH (p = 0.0011 by log-rank test). The independent predictor of adverse events using a Cox proportional hazards regression analysis was E/E��� at 50W (p<0.001, HR 1.16, 95% CI 1.08-1.24) in patients with EIPH. Conclusion In patients with preserved LV ejection fraction, EIPH provides prognostic information. An increase in LVFP during exercise is an independent predictor of adverse outcomes in patients with EIPH.