Pulmonary Hemodynamic Response to Exercise in Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy

Abstract

put (CO) from 4.4 ± 0.8 to 6.5 ± 1.9 l/min and diastolic pulmonary gradient (DPG) from 14.6 ± 4.9 to 20.7 ± 12.7 mm Hg. Post-PEA mPAP increased from 23.7 ± 6.6 at rest to 43.2 ± 7.1 mm Hg, while CO increased to a higher extent from 5.1 ± 0.9 to 8.4 ± 1.9 l/min. There were significant correlations between pre-PEA DPG/CO and dPAP/CO slopes with the pulmonary vascular resistance (Spearman r = 0.578, p = 0.019, and r = 0.547, p = 0.028) and mPAP at rest after PEA (Spearman r = 0.581, p = 0.018, and r = 0.546, p = 0.028). Conclusions: In CTEPH, the presurgical dynamic DPG/CO and dPAP/ CO slopes during submaximal exercise are associated with the hemodynamic outcome 1 year after PEA.

Long‐term changes of resting and exercise right ventricular systolic performance in patients with chronic thromboembolic pulmonary hypertension following pulmonary thromboendarterectomy – A two‐dimensional and three‐dimensional echocardiographic study

“…Previous studies have shown that clinical functional status assessed with NYHA classification or direct assessment of exercise tolerance by 6‐minute walk test or VO 2 improves significantly after PEA . In accordance with these previous findings, we demonstrated significant improvement in exercise capacity as maximal oxygen consumption increased significantly during follow‐up.…”

“…After PEA, the afterload decreases, leading to increase in RV free- 3,11,12,35 In accordance with these previous findings, we demonstrated significant improvement in exercise capacity as maximal oxygen consumption increased significantly during follow-up.…”

“…[5][6][7][8][9][10] A few studies have examined the association between RV systolic function in relation to physical capacity in CTEPH patients undergoing PEA. 3,[11][12][13][14][15] The existing exercise hemodynamic and echocardiographic studies evaluating the effect of PEA in CTEPH patients are characterized by different methodological designs regarding level of workload, post-PEA examination timing, level of pulmonary arterial pressure and absence of simultaneous echocardiographic and exercise testing. 3,[11][12][13][14][15] The association between symptoms, disease severity measured by RV systolic function, and prognosis has routinely been evaluated during resting conditions using 2D Doppler echocardiography.…”

“…3,[11][12][13][14][15] The existing exercise hemodynamic and echocardiographic studies evaluating the effect of PEA in CTEPH patients are characterized by different methodological designs regarding level of workload, post-PEA examination timing, level of pulmonary arterial pressure and absence of simultaneous echocardiographic and exercise testing. 3,[11][12][13][14][15] The association between symptoms, disease severity measured by RV systolic function, and prognosis has routinely been evaluated during resting conditions using 2D Doppler echocardiography. Furthermore, a substantial number of CTEPH patients still experience dyspnea on exertion and limitation of exercise capacity after surgical PEA.…”

Update in Pulmonary Vascular Disease 2015

“…Building on this concept, an increase in the ratio of change in mPAP to change in CO between rest and exercise (mPAP-CO slope) greater than 3 mm Hg/L/min was shown to associate with further limitations in peak V : O 2 and ventilation in patients with interstitial lung disease (10). Another study found that the 6-minute-walk distance (6-MWD), when combined with echocardiography, could provide a noninvasive estimate of TPR and that an mPAP-CO slope greater than 3.3 mm Hg/L/min was predictive of developing PAH (11), while alterations in the mPAP-CO slope correlate with hemodynamic improvement 1 year after pulmonary endarterectomy or after medical therapy with sildenafil for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) (12,13).…”