Pulmonary artery pressure measurement during exercise testing in patients with suspected pulmonary hypertension

Abstract

It is recognized that exercise produces abnormally large increases in pulmonary artery pressure in patients with pulmonary vascular disease as a consequence of a variety of disorders, but the relationship between pressure and cardiopulmonary exercise performance is poorly understood. This lack of understanding is due (in part) to difficulty making measurements of pulmonary haemodynamics using conventional fluid filled catheters. This article seeks to improve understanding by comparing variables measured during formal exercise testing with simultaneous measurements of pulmonary artery pressure using a micro-manometer tipped catheter.Ten patients with suspected pulmonary hypertension were studied using a micromanometer tipped pulmonary artery catheter, during cardiopulmonary exercise testing.Ventilatory equivalents for oxygen and carbon dioxide correlated with the pulmonary artery pressure measured on exercise, but oxygen pulse and oxygen uptake did not. Ventilatory equivalents, noninvasively measured during exercise, may merit further study as potential surrogates of pulmonary artery pressure and hence be useful in identifying individuals at risk of developing pulmonary hypertension. Eur Respir J 2000; 16: 282±287.

Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

“…Few studies have used right heart catheterization to address whether an mPAP Ͼ30 mm Hg during exercise represents an aberrant pulmonary vascular system in "at-risk" populations (19,21,28,34,38,39,43). Recently, Tolle and coworkers evaluated a large cohort of non-SSc symptomatic patients who underwent simultaneous cardiopulmonary exercise testing and right heart catheterization (21).…”

Impact of Cystic versus Cylindrical Types of Bronchiectasis on Pulmonary and Cardiac Functions

“…A previous study [30] on bronchiectasis emphasized that obstructive pulmonary insufficiency was related to morphologic changes and bronchial responsiveness. Obliterative bronchiolitis of small and medium airways together with secretions and associated emphysematous changes all contribute to pulmonary function deterioration associated with obstructive disease [31,32]. The above findings of deteriorating pulmonary physiology, particularly in patients with cystic bronchiectasis, have an important role in the pathogenesis of PH and suggest that PH is a marker of lung damage in these patients.…”

Chronic Thromboembolic Pulmonary Hypertension: Effects of Pulmonary Endarterectomy

“…As discussed, advanced pulmonary hypertension in CTEPH leads to chronic RV volume overload, cardiac remodelling and dysfunction. The limitation in exercise capacity is in major part caused by the inability of the heart to sufficiently increase pulmonary blood flow due to a decreased RV stroke volume response during exercise (Raeside et al, 2000;Holverda et al, 2006). Normally, upon exercise cardiac output is elevated by increasing heart rate, stroke volume or both.…”

“…As a result, the pulmonary pressure will rise in order to maintain pulmonary blood flow with a subsequent effect on stroke volume upon exercise. The exerciseassociated increase in pulmonary arterial pressure will result in further impairment of RV function, as well as LV underfilling, both leading to a failing stroke volume response to exercise (Raeside et al, 2000). Stroke volume is determined by contractility and the enddiastolic volume (EDV).…”