The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension
Abstract
:1. Introduction
2. Exercise Haemodynamics
2.1. Invasive Measurement
2.2. Non-Invasive Measurements
3. Cardiopulmonary Exercise Testing
Study | Population | Finding |
---|---|---|
Left Heart Disease | ||
Deboeck 2004 [100] | LHD (19), PAH (19) | Matched for peak VO2, PAH patients have
|
Hansen 2007 [101] | Normal (25), COPD (25), LHD (25), IPAH (25) | Matched for peak VO2, lower peak PetCO2 in PAH |
Groepenhoff 2010 [102] | PAH ( 28), LHD (18) | Matched for peak VO2, PAH patients have
|
Nishio 2012 [103] | LHD (20), PAH (20) | Matched for NYHA FC, peak VO2 lower and VE/VCO2 slope higher in PAH. Peak VO2 correlated with PVR in PAH and PAOP in LHD. VE/VCO2 slope correlated with PAOP in LHD |
Guazzi 2013 [104] | LHD (293); (134 had PH on TTE) | Presence of PH associated with high VE/VCO2 slope, low peak PetCO2 and presence of oscillatory breathing |
COPD | ||
Hansen 2007 [101] | Normal (25), COPD (25), LHD (25), IPAH (25) | Matched for peak VO2, PAH patients have lower peak PetCO2, higher peak PeCO2 and higher peak PeCO2/ PetCO2 ratio |
Vonbank 2008 [105] | COPD (42); PH determined by RHC present in 32 | Not matched for peak VO2 (lower in PH). Presence of PH during exercise associated with
|
Boerrigter 2012 [106] | COPD (47); (stratified for severity of PH determined at RHC – no PH (24), mPAP 25-39 mmHg (14), mPAP ≥ 40 mmHg (9) | As PH severity increased,
– switch from ventilatory to cardiovascular limitation profile |
IPF | ||
Glaser 2009 [107] | IPF (34); PH determined by TTE and confirmed by RHC in 16 | Not matched for peak VO2 (lower in PH). Presence of PH associated with
|
van der Plas 2013 [108] | IPF (38) ; mPAP ≥ 40 mmHg on TTE in 11 | VE/VCO2 at AT higher in group with mPAP ≥ 40 mmHg |
CTEPH | ||
Zhai 2011 [9] | PAH (77), CTEPH (50) | CTEPH patients had
|
McCabe 2013 [109] | CTEPH (15), CTED (15) | Not matched for peak VO2. CTEPH patients had
|
Significant CPET Variables | Studies |
---|---|
Peak VO2 | Wensel 2002 (absolute value) [110], Wensel 2013 (% predicted) [111] |
Peak systolic BP | Wensel 2002 [110] |
VE/VCO2 at AT | Oudiz 2010 [112], Deboeck 2012 [92] |
Δ O2 pulse | Groepenhoff 2008 [113] |
Peak HR / ΔHR | Groepenhoff 2013 [91] / Wensel 2013 [111] |
Change in peak VO2 with treatment | Groepenhoff 2013 [91] |
Presence of right to left shunt | Oudiz 2010 [112] |
Study | Population | Finding in EIPAH |
---|---|---|
Tolle 2008 [34] | Unexplained dyspnoea and fatigue with EIPAH (n = 78) | Reduced peak VO2, increased peak Aa gradient |
Dumitrescu 2010 [114] | Scleroderma (n = 30) | Lower VO2 at peak and AT, lower peak O2 pulse; lower VO2 – WR slope, higher VE/VCO2 and lower PetCO2 at AT |
Fowler 2011 [33] | Dyspnoea in scleroderma, family history of PAH, borderline PH (sPAP 35-45 mmHg on resting TTE) (n = 57) | Elevated VE/VCO2 and reduced PetCO2 at AT |
Schwaiblmair 2012 [115] | Borderline PH (mPAP 21-24 mmHg on RHC) (n = 53) | Reduced peak VO2, increased VE/VO2 at AT, increased VD/VT, increased Aa gradient, increased P(a-et)CO2 |
4. Field Exercise Tests
5. Future of Exercise Testing in PAH
Invasive Haemodynamics | Non-invasive haemodynamics | CPET | Field tests | |
---|---|---|---|---|
Screening | - | ++ | ++ | - |
Diagnosis | ++ | + | + | - |
Prognosis | + | + | + | ++ |
Follow-up | - | ++ | + | ++ |
6. Conclusion
Author Contributions
Conflicts of Interest
References
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Johnson, M.K.; Thomson, S. The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension. Diseases 2014, 2, 120-147. https://doi.org/10.3390/diseases2020120
Johnson MK, Thomson S. The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension. Diseases. 2014; 2(2):120-147. https://doi.org/10.3390/diseases2020120
Chicago/Turabian StyleJohnson, Martin K., and Stephen Thomson. 2014. "The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension" Diseases 2, no. 2: 120-147. https://doi.org/10.3390/diseases2020120