Effect of Supervised Training Therapy on Pulmonary Arterial Compliance and Stroke Volume in Severe Pulmonary Arterial Hypertension and Inoperable or Persistent Chronic Thromboembolic Pulmonary Hypertension

Abstract

<b><i>Background:</i></b> Pulmonary arterial compliance (PAC) is a prognostic parameter in pulmonary arterial hypertension (PAH) reflecting the elasticity of the pulmonary vessels. <b><i>Objectives:</i></b> The objective of this post hoc analysis of a prospective randomized controlled trial (RCT) was to assess the effect of exercise training on PAC and stroke volume (SV) in patients with PAH and persistent/inoperable chronic thromboembolic pulmonary hypertension (CTEPH). <b><i>Method:</i></b> From the previous RCT, 43 out of 87 patients with severe PAH (<i>n</i> = 29) and CTEPH (<i>n</i> = 14) had complete haemodynamic examinations at baseline and after 15 weeks by right heart catheterization and were analysed (53% female, 79% World Health Organization functional class III/IV, 58% combination therapy, 42% on supplemental oxygen therapy, training group <i>n</i> = 24, and control group <i>n</i> = 19). Medication remained unchanged for all patients. <b><i>Results:</i></b> Low-dose exercise training at 4–7 days/week significantly improved PAC (training group 0.33 ± 0.65 mL/mm Hg vs. control group −0.06 ± 1.10 mL/mm Hg; mean difference 0.39 mL/mm Hg, 95% confidence interval [CI] 0.15–0.94 mL/mm Hg; <i>p</i> = 0.004) and SV (training group 9.9 ± 13.4 mL/min vs. control group −4.2 ± 11.0 mL/min; mean difference 14.2 mL, 95% CI 6.5–21.8 mL; <i>p</i> < 0.001) in the training versus control group. Furthermore, exercise training significantly improved cardiac output and pulmonary vascular resistance at rest, peak oxygen consumption, and oxygen pulse. <b><i>Conclusions:</i></b> Our findings suggest that supervised exercise training may improve right ventricular function and PAC at the same time. Further prospective studies are needed to evaluate these findings.

Improving Quality of Life in Pulmonary Hypertension with Exercise Training Therapy

“…Pulmonary hypertension is a clinical condition in which there is an increase in pulmonary circulation pressure, characterized by an average pulmonary artery pressure >25 mmHg at rest, an expiratory pulmonary artery wedge pressure of 15 mmHg, and pulmonary vascular resistance > 3 wood units. (5) Pulmonary hypertension can usually be divided into idiopathic pulmonary arterial hypertension and those associated with congenital heart disease, systemic-to-pulmonary shunts, rheumatic diseases, portal hypertension, and human immunodeficiency virus infection. (6) In pulmonary hypertension, the pulmonary vascular lesions primarily involve the small pulmonary arteries (<500 mm in diameter).…”

“…(4) Thus, exercise training can be an alternative therapy to improves peak oxygen consumption and haemodynamics in patients with PH. (5) In this case report, we discuss Pulmonary Hypertension in ASD who are given therapy in the form of exercise training, and the results show that exercise training can improve the quality of life in patients in addition to providing pharmacological therapy.…”

Right Heart Size and Right Ventricular Reserve in Pulmonary Hypertension: Impact on Management and Prognosis

“…In addition, a post-hoc analysis of right heart catheterization data showed a significant improvement of PAC by exercise training in PAH and CTEPH [57]. Low-dose exercise training at 4-7 days/week significantly improved PAC (training group 0.33 ± 0.65 mL/mmHg vs. control group −0.06 ± 1.10 mL/mmHg; mean difference 0.39 mL/mmHg, 95% confidence interval (CI) 0.15 to 0.94 mL/mmHg; p = 0.004) and stroke volume (training group 9.9 ± 13.4 mL/min vs. control group −4.2 ± 11.0 mL/min; mean difference 14.2 mL, 95% CI 6.5 to 21.8 mL; p < 0.001) in the training vs. control group [57]. These findings suggest that supervised exercise training might improve RV function and PAC at the same time.…”

Hemodynamic indices in pulmonary hypertension: a narrative review

“…In patients with PAH, the SV correlates with World Health Organization functional class and its change during exercise was a predictor of morbidity and mortality (28)(29)(30). Additionally, a post hoc analysis of randomized control trials in patients with PAH and chronic thromboembolic pulmonary hypertension (CTEPH) showed that exercise training increased SV at 15 weeks by an average of 14.2 mL (31).…”