TY - JOUR
T1 - Hemodynamic and ventilatory responses during exercise in chronic thromboembolic disease
AU - van Kan, Coen
AU - van der Plas, Mart N.
AU - Reesink, Herre J.
AU - van Steenwijk, Reindert P.
AU - Kloek, Jaap J.
AU - Tepaske, Robert
AU - Bonta, Peter I.
AU - Bresser, Paul
PY - 2016
Y1 - 2016
N2 - Background: Patients with chronic thromboembolic disease (CTED) may suffer from exercise intolerance without pulmonary hypertension at rest. Pulmonary endarterectomy (PEA) for symptomatic CTED results in improvement of symptoms and quality of life. Neither the pathophysiology of the exercise limitation nor the underlying mechanisms of the PEA-induced improvement have been studied previously. Objectives: We studied hemodynamic and ventilatory responses upon exercise in 14 patients with CTED. After 1 year, we studied the underlying physiologic mechanisms of the PEA-induced symptomatic improvement. Methods: Cardiopulmonary exercise testing (CPET) was performed during right heart catheterization, and noninvasive CPET was performed 1 year postoperatively. Results: During exercise, we observed abnormal pulmonary vascular responses, that is, a steep mean pulmonary artery pressure/cardiac output (2.7 +/- 1.2 mm Hg.min.L-1), and low pulmonary vascular compliance (2.8 +/- 1.1 mL.mm Hg-1); mean pulmonary artery pressure/cardiac output slope correlated with dead-space ventilation (r = 0.586; P =.028) and ventilatory equivalents for carbon dioxide slope (r =.580; P =.030). Postoperatively, the improvement observed in exercise capacity was related to improvements in CPET-derived parameters pointing to restoration of right ventricle stroke volume response (oxygen pulse: 11.7 +/- 3.1 to 13.3 +/- 3.3; P = .027; heart rate response: 80.9 +/- 12.4 to 72.0 +/- 5.7; P = .003); and, indicating improved ventilatory efficiency, the ventilatory equivalents for carbon dioxide slope decreased from 38.2 +/- 3.6 to 32.8 +/- 7.0 (P = .014). Conclusions: Patients with CTED showed an abnormal pulmonary vascular response to exercise and a decreased ventilatory efficiency. Responses after PEA point to restoration of right ventricle stroke volume response and ventilatory efficiency
AB - Background: Patients with chronic thromboembolic disease (CTED) may suffer from exercise intolerance without pulmonary hypertension at rest. Pulmonary endarterectomy (PEA) for symptomatic CTED results in improvement of symptoms and quality of life. Neither the pathophysiology of the exercise limitation nor the underlying mechanisms of the PEA-induced improvement have been studied previously. Objectives: We studied hemodynamic and ventilatory responses upon exercise in 14 patients with CTED. After 1 year, we studied the underlying physiologic mechanisms of the PEA-induced symptomatic improvement. Methods: Cardiopulmonary exercise testing (CPET) was performed during right heart catheterization, and noninvasive CPET was performed 1 year postoperatively. Results: During exercise, we observed abnormal pulmonary vascular responses, that is, a steep mean pulmonary artery pressure/cardiac output (2.7 +/- 1.2 mm Hg.min.L-1), and low pulmonary vascular compliance (2.8 +/- 1.1 mL.mm Hg-1); mean pulmonary artery pressure/cardiac output slope correlated with dead-space ventilation (r = 0.586; P =.028) and ventilatory equivalents for carbon dioxide slope (r =.580; P =.030). Postoperatively, the improvement observed in exercise capacity was related to improvements in CPET-derived parameters pointing to restoration of right ventricle stroke volume response (oxygen pulse: 11.7 +/- 3.1 to 13.3 +/- 3.3; P = .027; heart rate response: 80.9 +/- 12.4 to 72.0 +/- 5.7; P = .003); and, indicating improved ventilatory efficiency, the ventilatory equivalents for carbon dioxide slope decreased from 38.2 +/- 3.6 to 32.8 +/- 7.0 (P = .014). Conclusions: Patients with CTED showed an abnormal pulmonary vascular response to exercise and a decreased ventilatory efficiency. Responses after PEA point to restoration of right ventricle stroke volume response and ventilatory efficiency
U2 - https://doi.org/10.1016/j.jtcvs.2016.05.058
DO - https://doi.org/10.1016/j.jtcvs.2016.05.058
M3 - Article
C2 - 27372842
SN - 0022-5223
VL - 152
SP - 763
EP - 771
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -