Diagnostic concordance of different criteria for exercise pulmonary hypertension in subjects with normal resting pulmonary artery pressure (original) (raw)
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Respiratory Medicine, 2016
Introduction: Great ventilation to carbon dioxide output (D _ VE/D _ VCO 2) and reduced end-tidal partial pressures for CO 2 (PETCO 2) during incremental exercise are hallmarks of chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (IPAH). However, CTEPH is more likely to involve proximal arteries, which may lead to poorer right ventricleepulmonary vascular coupling and worse gas exchange abnormalities. Therefore, abnormal PETCO 2 profiles during exercise may be more prominent in patients with CTEPH and could be helpful to indicate disease severity. Methods: Seventy patients with CTEPH and 34 with IPAH underwent right heart catheterization and cardiopulmonary exercise testing. According to PETCO 2 pattern during exercise, patients were classified as having an increase or stabilization in PETCO 2 up to the gas exchange threshold (GET), an abrupt decrease in the rest-exercise transition or a progressive and slow decrease throughout exercise. A subgroup of patients with CTEPH underwent a constant work rate exercise test to obtain arterial blood samples during steady-state exercise. Results: Multivariate logistic regression analyses showed that progressive decreases in PETCO 2 and SpO 2 were better discriminative parameters than D _ VE/D _ VCO 2 to distinguish CTEPH from IPAH. This pattern of PETCO 2 was associated with worse functional impairment and greater reduction in PaCO 2 during exercise. Conclusion: Compared to patients with IPAH, patients with CTEPH present more impaired gas exchange during exercise, and PETCO 2 abnormalities may be used to identify more clinically and hemodynamically severe cases.
Clinical Cardiology
Background: Among subjects with exercise intolerance and suspected early-stage pulmonary hypertension (PH), early identification of pulmonary vascular disease (PVD) with noninvasive methods is essential for prompt PH management. Hypothesis: Rest gas exchange parameters (minute ventilation to carbon dioxide production ratio: V E /VCO 2 and end-tidal carbon dioxide: ETCO 2) can identify PVD in early-stage PH. Methods: We conducted a retrospective review of 55 subjects with early-stage PH (per echocardiogram), undergoing invasive exercise hemodynamics with cardiopulmonary exercise test to distinguish exercise intolerance mechanisms. Based on the rest and exercise hemodynamics, three distinct phenotypes were defined: (1) PVD, (2) pulmonary venous hypertension, and (3) noncardiac dyspnea (no rest or exercise PH). For all tests, *p < .05 was considered statistically significant. Results: The mean age was 63.3 ± 13.4 years (53% female). In the overall cohort, higher rest V E /VCO 2 and lower rest ETCO 2 (mm Hg) correlated with high rest and exercise pulmonary vascular resistance (PVR) (r~0.5-0.6*). On receiver-operating characteristic analysis to predict PVD (vs. non-PVD) subjects with noninvasive metrics, area under the curve for pulmonary artery systolic pressure (echocardiogram) = 0.53, rest V E /VCO 2 = 0.70* and ETCO 2 = 0.73*. Based on this, optimal thresholds of rest V E /VCO 2 > 40 mm Hg and rest ETCO 2 < 30 mm Hg were applied to the overall cohort. Subjects with both abnormal gas exchange parameters (n = 12, vs. both normal parameters, n = 19) had an exercise PVR 5.2 ± 2.6* (vs. 1.9 ± 1.2), mPAP/CO slope
Criteria for diagnosis of exercise pulmonary hypertension
European Respiratory Journal, 2015
The previous definition of exercise pulmonary hypertension (PH) with a mean pulmonary artery pressure (mPAP) >30 mmHg was abandoned because healthy individuals can exceed this threshold at high cardiac output (CO). We hypothesised that incorporating assessment of the pressure–flow relationship using the mPAP/CO ratio, i.e. total pulmonary resistance (TPR), might enhance the accuracy of diagnosing an abnormal exercise haemodynamic response.Exercise haemodynamics were evaluated in 169 consecutive subjects with normal resting mPAP ≤20 mmHg. Subjects were classified into controls without heart or lung disease (n=68) versus patients with pulmonary vascular disease (PVD) (n=49) and left heart disease (LHD) (n=52).TPR and mPAP at maximal exercise produced diagnostic accuracy with area under the receiver operating curve of 0.99 and 0.95, respectively, for discriminating controls versus patients with PVD and LHD. The old criterion of mPAP >30 mmHg had sensitivity of 0.98 but specificit...
Respiration, 2013
Background: Pulmonary hypertension (PH) is common in interstitial lung disease (ILD). Since cardiopulmonary exercise testing (CPET) is useful in understanding the pathophysiology of respiratory disorders and can distinguish between ventilation and perfusion (V/Q) defects, it may have a role in the detection of PH in ILD. We evaluated whether CPET can detect PH through analysis of V/Q defects in ILD. Objectives: We aimed to use CPET to determine if there are changes in the ventilation and the activity pattern of mixed-expired carbon dioxide pressure (PE CO 2 ) and end-tidal carbon dioxide pressure (Pet CO 2 ) in ILD patients with and without PH. Methods: A retrospective chart review was done of all patients who received lung transplants at the Columbia University Medical Center between 2000 and 2011 with the diagnosis of ILD. CPETs were performed during the 2 years prior to transplantation; right heart catheterizations and pulmonary function tests were performed within 4 months of CPET. Results: The ILD patients with PH demonstrated significantly
CHEST Journal, 1995
We undertook the present study with the following objectives: (1) to compare the difference between the endtidal and the arterial carbondioxide concentration (P[ETa] C02) gradients at rest and during exercise in normal subjects and patients with COPD; and (2) to analyze the factors contributing to this gradient. We studied seven normal subjects and seven patients with COPD using a symptom-limited exercise test on a cycle ergometer. Our results show that the P(ET-a)CO2 increased progressively as the individuals went from rest to higher workloads in both the normal group and in the COPD group. The P(ET-a)CO2 in patients with COPD both at rest (-3.24±2.78 mm Hg) and during exercise (1.03±2.23 mm Hg) is significantly lower than that in normal individuals at rest (1.84 ± 3.68 mm Hg) and during exercise (10.3 ± 6.5 mm Hg) (p<0.01). However, the slope for the relationship between the P(ET-a)CO2 and the workload is actually significantly steeper in the patients with COPD. Although the P(ET-a)CO2 correlated significantly with the workload in both normal subjects (r=0.63, p<0.001) and patients (r=0.55, p<0.005), the P(ET-a)CO2 was much more closely correlated with the ratio of dead space to tidal volume (VD/VT) (r values of -0.86 and -0.77, respectively). Moreover, when multiple regression analysis was performed, addition of any other physiologic measure (eg, oxygen consumption [Vo2], carbon dioxide production [Vco2], minute ventilation [VE], or workload) as a second independent variable af-3he end-tidal Pco2 (PETCO2) has been used as an index of the arterial Pco2 (PaCO2) in many different situations.1-5 In general, most articles have concluded that the PETCO2 is a good index of the PaCO2. 1, We recently completed a study involving normal volunteers and patients with severe COPD who had the PETCO2 and the PaCO2 measured at rest and during exercise. We were surprised when we found that the PETCO2 was substantially higher than the CA 90822 ter the VD/VT did not improve the correlation. This indicates that the correlation between the P(ET-a)CO2 and the workload is probably related to the dependence of the VD/VT on the workload. The PaCO2 in normal subjects and in the COPD group correlated significantly with the partial pressure of end-tidal carbon dioxide (PETCO2). Using multiple regression analysis, with the PaCO2 as the dependent variable and the PETCO2 (along with other physiologic measures) as the independent variables, we found that the standard error of the estimate was still above 2.1 mm Hg in normal subjects and in patients with COPD. We conclude that (1) during exercise, the P(ET-a)CO2 in normal subjects and in patients with COPD increases significantly, (2) the P(ET-a)CO2 gradient is more closely correlated with the VD/VT than any other physiologic variable, and (3) changes in the PETCO2 during exercise are not correlated closely with changes in the PaCO2.
2012
printing supported by . Visit Chiesi at Stand B2.10 TUESDAY, SEPTEMBER 4TH 2012 3 weeks of ET. The 1and 2-year overall-survival rates were 100%, the 3-year survival 73%. In one patient lung transplantation was performed 6 months after ET. Conclusion: ET as add-on to medical therapy is effective in patients with CTDAPAH to improve work capacity, quality of life and prognostic parameters and improves the 1-, 2and 3-year survival rate. Further randomized controlled studies are needed to confirm these results. P4434 Respiratory muscle training (REMT) with normocapnic hyperpnoea (NH) improves respiratory muscle strength, exercise performance and ventilatory pattern in COPD patients Eva Bernardi, Luca Pomidori, Gaia Mandolesi, Gianluca Grassi, Annalisa Cogo. Department of Clinical and Experimental Medicine, University of Ferrara, FE, Italy Few data are available about the effect of RMET in COPD patients even if it has been shown that RMET improves endurance performance and decreases VE du...
International journal of cardiology, 2018
Pulmonary hypertension (PH) patients show, during exercise, an excessive increase in ventilation (V) compared to carbon dioxide output (VCO), determining a high V/VCO slope. There are several possible causes, including an elevated dead space ventilation (V), V/perfusion (Q) mismatch and/or an enhanced peripheral or central chemoreceptor activity. We evaluated the causes of exercise hyperventilation in PH patients. Eighteen group I and IV PH patients underwent cardiopulmonary exercise test with blood gas analysis at every minute. V, alveolar ventilation (V) and V vs. VCO relationship were calculated. Resting chemoreceptor sensitivity was analyzed through hypoxia/hypercapnia tests. PeakVO and V/VCO slopes were 1.06±0.24l/min and 39.1±9.0, respectively. Throughout the exercise, 30% of V was due to V. V/VCO slope significantly correlated with V/VCO slope (r=0.82, p<0.001) but not with V/VCO slope (r=0.3, p=ns). Peak exercise end-tidal CO (PetCO) correlated with V/VCO slope (r=-0.79, ...
Cardiopulmonary Exercise Testing in Pulmonary Hypertension
International Journal of Cardiovascular Sciences, 2016
The cardiopulmonary exercise test (CPET) is a complementary test that provides important data about the patient's actual functional capacity, metabolic and ventilatory responses, and gas exchange. Thus, it enables a classification of the cardiorespiratory fitness of an individual and identification of disorders that limit exercise continuity by analyzing several variables drawn from this diagnostic and prognostic propaedeutic method. In this regard, situations that are relatively common in clinical practice but are not often identified, such as pulmonary hypertension (PH), can be better addressed, assessed, and measured. Thus, the analysis of exhaled gases using CPET may provide better PH management by enabling a classification of the aerobic capacity, ventilatory response and gas exchange in patients with this pulmonary vascular disorder.