Augmented Ventilatory Response to Exercise in Pulmonary Hypertension

Theodore, James; Robin, Eugene D.; Morris, Adrian; Burke, Conor M.; Jamieson, Stuart W.; Kessel, Antonius Van; Stinson, Edward B.; Shumway, Norman E.

doi:10.1378/chest.89.1.39

Cited by 54 publications

(30 citation statements)

References 13 publications

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“…In contrast to Theodore et al [1986], we have observed a high degree of hyperpnea during the test as demon strated by the statistically different slopes of the line for minute ventilation over expira tory carbon dioxide production. Notwith standing the fact that both groups of patients (CABG and transplanted) had a ventilation in excess compared to normal subjects, in relation probably with the consequences of extracorporeal circulation (restrictive lung deficit) [Braun et al, 1978;Rea et al, 1978], heart recipients had a much higher degree of hyperpnea than the CABG patients.…”

Section: Discussioncontrasting

confidence: 80%

Psychosocial and Physical Rehabilitation after Heart Transplantation: 1-Year Follow-Up

Niset

Coustry-Degré²,

Degré³

1988

Cardiology

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Experience on the rehabilitation of 62 heart-transplanted patients with a mean follow-up period of 15 months and a total survival rate of 79% is reported. From the present study we may conclude that: (a) One month after surgery, oxygen consumption of transplanted patients compared to coronary artery bypass-grafted patients was statistically lower (p < 0.025). An excess ventilation was observed in transplanted patients in relation mainly to an excessive increase in blood lactates. (b) Improvement of maximal working capacity observed immediately after grafting was still enhanced after 1 year of a comprehensive rehabilitation program (p < 0.001). This improvement was more related with an improvement of the respiratory function and of the peripheral factors than with a circulatory effect, (c) Four months after transplantation 71 % of the patients still at work 6 months before operation returned to work, (d) The quality of life, well-being and heart acceptation demonstrated an immediate increase in physical items after transplantation while psychosocial items decreased postoperatively and normalized after weeks or months.

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Section: Discussioncontrasting

confidence: 80%

Psychosocial and Physical Rehabilitation after Heart Transplantation: 1-Year Follow-Up

Niset

Coustry-Degré²,

Degré³

1988

Cardiology

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“…V′E-V′CO 2 slope was reduced significantly after surgical (thromboendarterectomy and lung transplant) intervention and the decreases were strongly related to the reduction in PVR post-surgery [87,88]. V′E-V′CO 2 indices respond to pharmacological interventions: with phosphodiesterase-5 inhibitors [89], endothelin receptor antagonists [67] and prostanoids [90][91][92] in idiopathic PAH; with bosentan and sildenafil in adult patients with Eisenmenger syndrome [93]; and with beraprost in patients with thromboembolic pulmonary hypertension [94].…”

Section: Clinically Meaningful Differencementioning

confidence: 99%

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

et al. 2016

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This document reviews 1) the measurement properties of commonly used exercise tests in patients with chronic respiratory diseases and 2) published studies on their utilty and/or evaluation obtained from MEDLINE and Cochrane Library searches between 1990 and March 2015.Exercise tests are reliable and consistently responsive to rehabilitative and pharmacological interventions. Thresholds for clinically important changes in performance are available for several tests. In pulmonary arterial hypertension, the 6-min walk test (6MWT), peak oxygen uptake and ventilation/carbon dioxide output indices appear to be the variables most responsive to vasodilators. While bronchodilators do not always show clinically relevant effects in chronic obstructive pulmonary disease, high-intensity constant work-rate (endurance) tests (CWRET) are considerably more responsive than incremental exercise tests and 6MWTs. High-intensity CWRETs need to be standardised to reduce interindividual variability. Additional physiological information and responsiveness can be obtained from isotime measurements, particularly of inspiratory capacity and dyspnoea. Less evidence is available for the endurance shuttle walk test. Although the incremental shuttle walk test and 6MWT are reliable and less expensive than cardiopulmonary exercise testing, two repetitions are needed at baseline. All exercise tests are safe when recommended precautions are followed, with evidence suggesting that no test is safer than others. @ERSpublications A review of exercise testing to evaluate interventions aimed to improve exercise tolerance in respiratory patients

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“…The main underlying mechanisms are sympathetic overexcitation and increased chemosensitivity with hyperventilation-associated increased physiological dead space. Moreover, there is an inadequate increase in cardiac output during exercise, leading to a low mixed-venous and arterial oxygen saturation and early lactic acidosis that raises ventilatory requirements even further due to excessive CO 2 production (39,65,77). These mechanisms lead to arterial oxygen desaturation during exercise as a cardinal feature of PH with, consequently, reduced oxygen delivery to the muscles, the brain, and other organs, resulting in impaired exercise performance (28,37).…”

Section: Effect Of Hyperoxia On Exercise Performance In Patients With Phmentioning

confidence: 99%

Effect of hypoxia and hyperoxia on exercise performance in healthy individuals and in patients with pulmonary hypertension: a systematic review

Ulrich

Schneider

Bloch

2017

Journal of Applied Physiology

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Exercise performance is determined by oxygen supply to working muscles and vital organs. In healthy individuals, exercise performance is limited in the hypoxic environment at altitude, when oxygen delivery is diminished due to the reduced alveolar and arterial oxygen partial pressures. In patients with pulmonary hypertension, exercise performance is already reduced near sea level due to impairments of the pulmonary circulation and gas exchange and, presumably, these limitations are more pronounced at altitude. In studies performed near sea level in healthy subjects as well as in patients with pulmonary hypertension (PH) maximal performance during progressive ramp exercise and endurance of submaximal constant load exercise were substantially enhanced by breathing oxygen-enriched air. Both in healthy individuals and in PH-patients these improvements were mediated by a better arterial, muscular and cerebral oxygenation along with a reduced sympathetic excitation, as suggested by the reduced heart rate and alveolar ventilation at submaximal isoloads, and an improved pulmonary gas exchange efficiency, especially in patients with PH. In summary, in healthy individuals and in patients with pulmonary hypertension, alterations in the inspiratory PO2 by exposure to hypobaric hypoxia or normobaric hyperoxia reduce or enhance exercise performance, respectively, by modifying oxygen delivery to the muscles and the brain, by effects on cardiovascular and respiratory control and by alterations in pulmonary gas exchange. The understanding of these physiologic mechanisms helps counselling individuals planning altitude or air travel and prescribing oxygen therapy to patients with pulmonary hypertension. is determined by oxygen supply to working muscles and vital organs. In healthy individuals, exercise performance is limited in the hypoxic environment at altitude, when oxygen delivery is diminished due to the reduced alveolar and arterial oxygen partial pressures. In patients with pulmonary hypertension (PH), exercise performance is already reduced near sea level due to impairments of the pulmonary circulation and gas exchange, and, presumably, these limitations are more pronounced at altitude. In studies performed near sea level in healthy subjects, as well as in patients with PH, maximal performance during progressive ramp exercise and endurance of submaximal constant-load exercise were substantially enhanced by breathing oxygen-enriched air. Both in healthy individuals and in PH patients, these improvements were mediated by a better arterial, muscular, and cerebral oxygenation, along with a reduced sympathetic excitation, as suggested by the reduced heart rate and alveolar ventilation at submaximal isoloads, and an improved pulmonary gas exchange efficiency, especially in patients with PH. In summary, in healthy individuals and in patients with PH, alterations in the inspiratory PO 2 by exposure to hypobaric hypoxia or normobaric hyperoxia reduce or enhance exercise performance, respectively, by modifying oxygen deliv...

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Augmented Ventilatory Response to Exercise in Pulmonary Hypertension

Cited by 54 publications

References 13 publications

Psychosocial and Physical Rehabilitation after Heart Transplantation: 1-Year Follow-Up

Psychosocial and Physical Rehabilitation after Heart Transplantation: 1-Year Follow-Up

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

Effect of hypoxia and hyperoxia on exercise performance in healthy individuals and in patients with pulmonary hypertension: a systematic review

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