Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension

Ley, Sebastian; Fink, Christian; Risse, F.; Ehlken, Nicola; Fischer, Christine; Ley‐Zaporozhan, Julia; Kauczor, Hans‐Ulrich; Klose, Hans; Gruenig, Ekkehard

doi:10.1007/s00330-012-2606-z

Cited by 83 publications

(75 citation statements)

References 30 publications

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“…45,46 Furthermore, recent human studies have shown that exercise training is associated with significant improvements in central pulmonary perfusion and peripheral skeletal muscle function, which could also contribute to the training-related improvement in exercise capacity. 16,23 In this study, we observed a significant improvement in the pulmonary arterial systolic pressure with training, which could lead to significant reductions in pulmonary vascular resistance and a concomitant improvement in blood flow through the pulmonary vascular system. Improved pulmonary perfusion would be associated with improved oxygenation and cardiac output, thus leading to improvement in exercise tolerance and cardiorespiratory fitness.…”

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confidence: 58%

“…Several small studies have evaluated exercise training as an adjunctive therapeutic strategy in patients with chronic pulmonary hypertension. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Although most of these studies were small and not designed to address clinical end points, such as mortality or hospitalizations, related to pulmonary hypertension, they have demonstrated a variable degree of improvement in exercise tolerance and quality of life in response to training.Therefore, because of the uncertainty about the benefit of structured exercise training programs in patients with pulmonary hypertension, we performed this systematic review and meta-analysis to assess the efficacy and safety of structured exercise training regimens in patients with pulmonary hypertension. …”

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confidence: 99%

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Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension

Pandey

Garg

Khunger

et al. 2015

Circ: Heart Failure

108

110

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P ulmonary hypertension is a chronic cardiopulmonary disorder characterized by progressive increasing pulmonary vascular resistance, leading to right ventricular heart failure. 1 Prevalence of pulmonary hypertension is estimated to be 10 to 15 cases per million with a mortality rate of 15% per year. 2 Over the past 2 decades, targeted pharmacological therapies have been effective in reducing disease progression and improving the survival rate among patients with pulmonary hypertension.3,4 However, most patients remain symptomatic with significant exercise intolerance and reduced quality of life despite being on optimal medical therapy. 5,6 Thus, there is an unmet need for adjunctive therapeutic strategies to improve exercise tolerance and quality of life among these patients. Clinical Perspective on p 1043Exercise intolerance in patients with pulmonary hypertension is associated with a reduced maximal oxygen uptake and early onset of anaerobic threshold, similar to patients with severe heart failure. 7 The decrease in pulmonary vasculature distensibility associated with pulmonary hypertension leads to marked increases in pulmonary arterial mean pressure during exercise. This results in reduced pulmonary blood flow and low cardiac output insufficient to meet the metabolic demands of exercise. [7][8][9] Furthermore, pulmonary hypertension patients have significant skeletal muscle abnormalities leading to impaired peripheral oxygen utilization. These central and peripheral abnormalities contribute significantly to the exercise intolerance and functional limitation in patients with pulmonary hypertension. 10,11 Exercise training has been shown to improve cardiorespiratory fitness, functional status, and clinical outcomes in patients with cardiopulmonary conditions, such as heart failure and chronic obstructive pulmonary disease (COPD). 12,13 Considering the overlap in the pathophysiological derangements Original Article© 2015 American Heart Association, Inc.Circ Heart Fail is available at http://circheartfailure.ahajournals.org DOI: 10.1161/CIRCHEARTFAILURE.115.002130Background-Exercise training has been shown to improve cardiorespiratory fitness, physical capacity, and quality of life in patients with cardiopulmonary conditions, such as heart failure and chronic obstructive pulmonary disease. However, its role in management of pulmonary hypertension is not well defined. In this study, we aim to evaluate the efficacy and safety of exercise training in patients with pulmonary hypertension. Methods and Results-We included all prospective intervention studies that evaluated the efficacy and safety of exercise training in patients with pulmonary hypertension. Primary outcome of this meta-analysis was a change in 6-minute walk distance. We also assessed the effect of exercise on peak oxygen uptake, resting pulmonary arterial systolic pressure, peak exercise heart rate, and quality of life. A total of 469 exercise-training participants enrolled in 16 separate training studies were included. In the pooled ana...

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Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension

Pandey

Garg

Khunger

et al. 2015

Circ: Heart Failure

108

110

View full text Add to dashboard Cite

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“…Inicialmente, se pensaba que el incremento de la actividad física podía ser perjudicial para estos pacientes y que podía en realidad aumentar las presiones de arterias pulmonares y acerar el proceso proliferativo 21 . Actualmente, se ha observado mediante resonancia magnética un aumento significativo en la velocidad peak del flujo sanguíneo (p = 0,012) y de la perfusión pulmonar (p = 0,017) en el sujetos entrenados durante 3 semanas mientras el grupo control se mantuvo sin cambios significativos 22 . En una reciente revisión sistemá-tica y metanálisis de los artículos existentes de ejercicio en pacientes con HTP, se objetivó una reducción de la presión sistólica de arterias pulmonares en 3,7 mmHg, estadística-mente significativo 23 .…”

Section: Introductionunclassified

Beneficios del ejercicio en pacientes con hipertensión pulmonar: Revisión bibliográfica

Bascuñán

Cancino

2016

Rev Chil Cardiol

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“…These results were confirmed by Mainguy et al (45) who demonstrated a decreased proportion of type II muscle fibers and improvement in peripheral muscle characteristics as a consequence of ET in idiopathic PAH patients. A magnetic resonance imaging (MRI) study assessed the effects of 3-weeks in-hospital exercise training on pulmonary perfusion and blood flow in patients with PAH and CTEPH showing a significant improvement of MRI parameters of pulmonary perfusion and peak flow velocity in comparison with sedentary controls (46). In the physiologic study by Kabitz et al (47), seven PAH patients received supervised (physiotherapists and © C I C E d i z i o n i I n t e r n a z i o n a l i physicians) training every for a 15-week period showing a significant improvement of respiratory muscle strength assessed by twitch mouth pressure and exercise capacity (6MWD).…”

Section: The Pathophysiological Rationale Of Exercise Training In Pahmentioning

confidence: 99%

Exercise training for patients with pulmonary arterial hypertension

Confalonieri¹

2014

SOB

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ly activity, reducing dyspnoea and fatigue, and enhancing the quality of life and muscle strength. So, the final message from the available literature reports is a strong recommendation to adopt exercise training and cardiopulmonary rehabilitation programs for any patient suffering from exertional dyspnoea and fatigue. Many questions remain unanswered regarding the optimization of the exercise training and rehabilitation programs. Ongoing rehabilitative trials in patients with PAH will help answer some of the remaining questions.KEY WORDS: pulmonary arterial hypertension; dyspnoea; exercise limitation; exercise training; pulmonary rehabilitation. IntroductionPulmonary arterial hypertension (PAH) is a hemodynamic condition defined by a pre-capillary resting pulmonary artery pressure at or above 25 mm Hg mean value that can be the result of a variety of diseases of different causes, but similar clinical picture and virtually identical pathological changes of the distal pulmonary arteries (1, 2). During the Fifth World Symposium on pulmonary hypertension (PH) held in 2013 in Nice, the clinical classification of pulmonary hypertension (2) identified five groups of disorders according to pathological, pathophysiological and therapeutic characteristics, but the term PAH may only be applied to a subgroup of the group 1 including eight rare clinical conditions characterized by pre-capillary PH in absence of other causes of pre-capillary PH such as lung diseases, chronic pulmonary thromboembolism (CTEPH), or rare diseases related-PH with unclear multi-factorial mechanisms. Despite a number of specific drugs are available by now for PAH treatment, exertional dyspnoea is a common progressively disabling symptom, shared either by idiopathic and secondary PAH, still affecting well treated patients. Exercise training (ET), a major component of pulmonary rehabilitation programs, is an established treatment to enhance exercise limitation for patients with chronic obstructive pulmonary disease (COPD), systolic left heart failure, and a variety of chronic respiratory diseases (3 SummaryIn spite of evidence-based consensus recommendations on exercise training for patients with pulmonary arterial hypertension (PAH) its use outside specialized rehabilitation Centers has been accounted a handful of reports. Dyspnoea and fatigue are common symptoms reducing the exercise tolerance of subjects with PAH even when specific drug are correctly administered. Moreover, the mechanisms of exercise limitation in subjects with PAH are known and thandful of reports. There is evidence of impaired signaling between the periphery and central hemodynamic performance. Exercise training has recently been proven to be effective and safe to enhance physical performance in patients with PAH already treated with specific drug therapy. The rationale of training in PAH has been specifically proven also in experimental animal models of PAH. Moreover, repeated positive results in randomized controlled trials and observational studies in humans gave convincing ...

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Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension

Cited by 83 publications

References 30 publications

Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension

Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension

Beneficios del ejercicio en pacientes con hipertensión pulmonar: Revisión bibliográfica

Exercise training for patients with pulmonary arterial hypertension

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