Exercise Pathophysiology in Patients With Primary Pulmonary Hypertension

Abstract

Background-Patients with primary pulmonary hypertension (PPH) have a pulmonary vasculopathy that leads to exercise intolerance due to dyspnea and fatigue. To better understand the basis of the exercise limitation in patients with PPH, cardiopulmonary exercise testing (CPET) with gas exchange measurements, New York Heart Association (NYHA) symptom class, and resting pulmonary hemodynamics were studied. Methods and Results-We retrospectively evaluated 53 PPH patients who had right heart catheterization and cycle ergometer CPET studies to maximum tolerance as part of their clinical workups. No adverse events occurred during CPET. Reductions in peak O 2 uptake (V O 2 ), anaerobic threshold, peak O 2 pulse, rate of increase in V O 2 , and ventilatory efficiency were consistently found. NYHA class correlated well with the above parameters of aerobic function and ventilatory efficiency but less well with resting pulmonary hemodynamics. Conclusions-Patients

Diagnosis of CTEPHversusIPAH using capillary to end-tidal carbon dioxide gradients

“…The most important parameters are considered to be V9O 2 ,max and EQCO 2 at the anaerobic threshold [14], and it has been shown that V9O 2 ,max has prognostic relevance in IPAH [15]. Our data suggest that spiroergometry also indicates whether pulmonary blood flow is heterogeneous in comparison to ventilation.…”

“…Ventilation was slightly increased in CTEPH at rest and during exercise (15 (4-21) versus 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) and 58 (29-78) versus 50 (29-82) L?min -1 ), but with no significant difference between the two groups. There were no significant differences between CTEPH and IPAH in oxygen uptake upon maximal exercise (table 3), and tidal volume at rest and at maximal exercise (0.7 (0.4-1.3) versus 0.7 (0.5-1.4) and 1.9 (0.7-2.3) versus 1.9 (1.3-3.1) L, respectively).…”

“…We found that in IPAH patients, EQCO 2 was inversely correlated with V9O 2 ,max. This can be explained by the fact that reduced pulmonary blood flow results in both a reduced V9O 2 ,max and an increased V9E/V9CO 2 ratio [14,16]. Interestingly, in the CTEPH group, there was no significant correlation between EQCO 2 and V9O 2 ,max.…”

The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

“…While there are techniques enabling detection of pulmonary hypertension in an early stage [91,92], it is still unclear whether routine assessment of these techniques is justified as part of the long-term follow-up of CDH.…”

Treatment of right heart failure on pulmonary arterial hypertension: is going left a step in the right direction?

“…In some patients, hypoxaemia is caused by right to left shunting through a patent foramen ovale [13]. In spite of vascular obliteration, dead space remains normal or near-normal, and increased physiological dead space only partly accounts for a resting and exercise hyperventilation that does not limit exercise capacity [14][15][16].…”