The pulmonary haemodynamics during exercise – research network (PEX-NET) ERS Clinical Research Collaboration: investigating the prognostic relevance of exercise haemodynamics

Kovàcs, Gabór; Hervé, Philippe; Olschewski, Horst

doi:10.1183/13993003.00458-2019

Cited by 16 publications

(8 citation statements)

References 9 publications

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“…The clinical relevance of impaired pulmonary vascular distensibility in term of its ability to distinguish LHD from PAH with confidence remains, however, unknown [173]. Hopefully, an ERS Clinical Research Collaboration called the pulmonary haemodynamics during exerciseresearch network (PEX-NET) will provide answers regarding prognostic relevance of ePH in terms of mortality/lung transplantation ( primary end-point) and hospitalisation, development of PH at rest, or initiation of targeted PAH medication (secondary end-points) [174].…”

Section: Gaps In Knowledgementioning

confidence: 99%

Exercise intolerance in pulmonary arterial hypertension: insight into central and peripheral pathophysiological mechanisms

et al. 2021

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Exercise intolerance is a cardinal symptom of pulmonary arterial hypertension (PAH) and strongly impacts patients' quality of life (QoL). Although central cardiopulmonary impairments limit peak oxygen consumption (V′O2peak) in patients with PAH, several peripheral abnormalities have been described over the recent decade as key determinants in exercise intolerance, including impaired skeletal muscle (SKM) morphology, convective O2 transport, capillarity and metabolism indicating that peripheral abnormalities play a greater role in limiting exercise capacity than previously thought. More recently, cerebrovascular alterations potentially contributing to exercise intolerance in patients with PAH were also documented. Currently, only cardiopulmonary rehabilitation has been shown to efficiently improve the peripheral components of exercise intolerance in patients with PAH. However, more extensive studies are needed to identify targeted interventions that would ultimately improve patients' exercise tolerance and QoL. The present review offers a broad and comprehensive analysis of the present literature about the complex mechanisms and their interactions limiting exercise in patients and suggests several gaps in knowledge that need to be addressed in the future for a better understanding of exercise intolerance in patients with PAH.

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Section: Gaps In Knowledgementioning

confidence: 99%

Exercise intolerance in pulmonary arterial hypertension: insight into central and peripheral pathophysiological mechanisms

et al. 2021

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“…However, as data on the normal ranges of hemodynamic variables, as well as on the prognostic and diagnostic relevance of pulmonary hemodynamics during exercise accumulate, the clinical value of exercise PH is emerging. In addition to the currently available studies, a large international collaborative effort (The pulmonary haemodynamics during exercise -research network [PEX-NET]) 37 is being conducted and will reveal data based on a large number of patients.…”

Section: Exercise Ph -Outlookmentioning

confidence: 99%

Exercise Pulmonary Hypertension

Zeder¹,

Olschewski²,

Kovàcs³

2022

BRN

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The clinical value of pulmonary hemodynamics during exercise has not been fully explored. In the last decade, several studies investigated the prognostic and diagnostic relevance of exercise hemodynamics and novel hemodynamic variables including the mean pulmonary arterial pressure (mPAP)/cardiac output (CO) slope and the pulmonary arterial wedge pressure (PAWP)/CO slope have been analyzed. These parameters describe the effects of pulmonary blood flow on the pulmonary pressure and were shown to be of prognostic relevance. In addition, they may also serve as tools to differentiate early forms of pulmonary vascular from left heart diseases. Right heart catheterization remains the gold standard to assess pulmonary hemodynamics both at rest and during exercise, while exercise echocardiography represents a promising non-invasive research tool. In this review, we provide an overview of the growing body of evidence on the clinical relevance of pulmonary hemodynamics during exercise and discuss its potential future role.

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“…„Grenzwerte“ für die pulmonale Hämodynamik unter Belastung definiert werden können, fehlen vergleichbare Daten auch für die iCPET-Untersuchungen. Im Rahmen der internationalen PEX-NET-Datenbank 158 sind Fortschritte auf diesem Gebiet zu erwarten. Neben den methodischen Fragen (Wahl der Körperposition bzw.…”

Section: Vorschlag Für Eine Erweiterung Des Bisherigen Icpet-algorithmusunclassified

Übersicht über die Entwicklung der invasiven Spiroergometrie (iCPET)

et al. 2021

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ZusammenfassungDie Standardmethode zur Messung der pulmonalen Hämodynamik ist der Rechtsherzkatheter (RHK) unter Ruhebedingungen, welcher international standardisiert ist. In den letzten Jahren wurden Bemühungen unternommen, auch die methodischen Aspekte des RHK unter Belastung zu vereinheitlichen und die somit gewonnenen Daten hinsichtlich ihrer prognostischen Aussagekraft zu definieren. Die Spiroergometrie als eine nichtinvasive Methode kann zusätzliche Aspekte der Pathophysiologie unter Belastung darstellen, und beide Methoden werden zunehmend kombiniert (als sog. invasive Spiroergometrie, iCPET) und ermöglichen eine sehr differenzierte Analyse der Belastungsreaktion.In dieser Übersicht werden die bisherigen Erfahrungen mit der invasiven Spiroergometrie dargestellt und insbesondere methodische Details erläutert.Die bisherigen Daten zur invasiven Spiroergometrie zeigen, dass diese komplexe Untersuchung besonders bei der Differenzierung der zugrundeliegenden Ursachen einer unklaren Dyspnoe hilfreich ist. Es zeichnet sich ab, dass über die Kombination aus hämodynamischen sowie ventilatorischen und gasanalytischen Daten schon frühe Formen einer kardialen bzw. pulmonalvaskulären Störung zu detektieren sind. Durch die zunehmende Validierung gewonnener Parameter aus der iCPET sind zukünftig Grenzwerte zur Unterscheidung normaler vs. pathologischer Belastungsreaktionen zu erwarten, die genauer als durch die alleinige Anwendung der jeweiligen Methoden möglich werden.

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The pulmonary haemodynamics during exercise – research network (PEX-NET) ERS Clinical Research Collaboration: investigating the prognostic relevance of exercise haemodynamics

Abstract: @ERSpublications PEX-NET is likely to provide answers regarding the prognostic relevance of pulmonary haemodynamics during exercise and will stimulate further research on the underlying pathophysiology, diagnosis and treatment of exercise pulmonary hypertension

Cited by 16 publications

References 9 publications

Exercise intolerance in pulmonary arterial hypertension: insight into central and peripheral pathophysiological mechanisms

Exercise intolerance in pulmonary arterial hypertension: insight into central and peripheral pathophysiological mechanisms

Exercise Pulmonary Hypertension

Übersicht über die Entwicklung der invasiven Spiroergometrie (iCPET)

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