Distinguishing Pulmonary Hypertension in Interstitial Lung Disease by Ventilation and Perfusion Defects Measured by Cardiopulmonary Exercise Testing

Armstrong, Hilary F.; Thirapatarapong, Wilawan; Dussault, Nicole; Bartels, Matthew N.

doi:10.1159/000350445

Cited by 16 publications

(23 citation statements)

References 16 publications

(23 reference statements)

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“…In the present study, even though mean group DLCO was lower in ILD+PVD compared with ILD−PVD, this difference was not statistically significant. In line with previous reports [19,21], the presence of pulmonary hypertension did not correlate with the severity of the restrictive ventilatory defect or the degree of desaturation on exertion. Age, sex, BMI and radiographic findings were also similar between ILD+PVD and ILD−PVD.…”

Section: Discussionsupporting

confidence: 92%

“…Previous studies have been able to show a relationship between reduced DLCO and increased prevalence of pulmonary hypertension in patients with ILD [10,[18][19][20]. In the present study, even though mean group DLCO was lower in ILD+PVD compared with ILD−PVD, this difference was not statistically significant.…”

Section: Discussioncontrasting

confidence: 79%

“…In the study by BOUTOU et al [1], SPAP correlated with peak V´O 2 , anaerobic threshold, peak oxygen pulse, end-tidal carbon dioxide tension (PETCO 2 ) at the anaerobic threshold and during peak exercise, as well as V´E/V´CO 2 at the anaerobic threshold, but only the latter was able to independently predict the presence of pulmonary hypertension. ARMSTRONG et al [19] showed that ILD subjects with pulmonary hypertension (n=25) have higher V´E/V´CO 2 as well as lower expiratory carbon dioxide tension and PETCO 2 , both at the anaerobic threshold and during peak exercise, compared with ILD patients without pulmonary vascular disease (n=50). The fact that between-group difference in VD/VT was not statistically significant was considered to be further evidence that the worse gas exchange pattern in ILD+PVD resulted mainly from perfusion abnormalities.…”

Section: Cpet In Ildmentioning

confidence: 99%

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Pulmonary vascular response patterns during exercise in interstitial lung disease

et al. 2015

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When overt pulmonary hypertension arises in interstitial lung disease (ILD), it contributes to exercise intolerance. We sought to determine the functional significance of abnormal pulmonary arterial pressure (PAP) responses to exercise in ILD.27 ILD patients and 11 age-matched controls underwent invasive cardiopulmonary exercise testing (iCPET). Mean PAP (mPAP) was indexed to cardiac output (Q´T) during exercise, with a mPAP-Q´T slope ⩾3 mmHg·min·L −1 defined as an abnormal pulmonary vascular response. All control subjects had mPAP-Q´T slopes <3 mmHg·min·L −1 (mean±SEM 1.5±0.1 mmHg·min·L −1 ). 15 ILD patients had mPAP-Q´T slopes ⩾3 mmHg·min·L −1 (4.1±0.2 mmHg·min·L) and were labelled as having ILD plus pulmonary vascular dysfunction (PVD). Subjects without pulmonary hypertension and with mPAP-Q´T slopes <3 mmHg·min·L −1 (1.9±0. 2 mmHg·min·L −1) were labelled as ILD minus PVD (n=12). ILD+PVD and ILD−PVD patients did not differ in terms of age, sex, body mass index, pulmonary function testing or degree of exercise oxygen desaturation. Peak oxygen consumption was lower in ILD+PVD than in ILD−PVD (13.0±0.9 versus 17±1.1 mL·kg , p=0.003). ILD+PVD patients had increased dead space volume (VD)/tidal volume (VT) and minute ventilation/carbon dioxide production at the anaerobic threshold.In ILD, mPAP-Q´T slope ⩾3 mmHg·min·L −1 is associated with lower peak oxygen consumption, increased VD/VT and inefficient ventilation. While noninvasive parameters were unable to predict those with abnormal pulmonary vascular responses to exercise, iCPET-derived mPAP-Q´T slope may aid in identifying physiologically significant, early pulmonary vascular disease in ILD.@ERSpublications PAP responses to exercise may help to refine resting phenotypes related to pulmonary vascular dysfunction in ILD http://ow.ly/M0nMa

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 79%

Section: Cpet In Ildmentioning

confidence: 99%

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Pulmonary vascular response patterns during exercise in interstitial lung disease

et al. 2015

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“…Furthermore, CPET has proved to be useful in distinguishing between ILD patients with and without pulmonary hypertension. In the retrospective study of ARMSTRONG et al [71], ILD patients with pulmonary hypertension demonstrated significantly lower end-tidal carbon dioxide tension PETCO 2 and mixed expired carbon dioxide pressure (PECO 2 ) during exercise with a distinctive activity pattern for PECO 2 /PETCO 2 . DEGANI-COSTA et al [72] aimed to determine the functional significance of abnormal pulmonary arterial pressure (PAP) responses to exercise in 27 ILD patients and 11 age-matched controls using invasive cardiopulmonary exercise testing.…”

Section: The Role Of Cardiopulmonary Exercise Test In Ildsmentioning

confidence: 99%

Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing

Bonini

Fiorenzano

2017

Eur Respir Rev

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Interstitial lung diseases (ILDs) represent a heterogeneous group of pathologies characterised by alveolar and interstitial damage, pulmonary inflammation (usually associated with fibrosis), decreased lung function and impaired gas exchange, which can be attributed to either a known or an unknown aetiology. Dyspnoea is one of the most common and disabling symptoms in patients with ILD, significantly impacting quality of life. The mechanisms causing dyspnoea are complex and not yet fully understood. However, it is recognised that dyspnoea occurs when there is an imbalance between the central respiratory efferent drive and the response of the respiratory musculature. The respiratory derangement observed in ILD patients at rest is even more evident during exercise. Pathophysiological mechanisms responsible for exertional dyspnoea and reduced exercise tolerance include altered respiratory mechanics, impaired gas exchange, cardiovascular abnormalities and peripheral muscle dysfunction.This review describes the respiratory physiology of ILD, both at rest and during exercise, and aims to provide comprehensive and updated evidence on the clinical utility of the cardiopulmonary exercise test in the assessment and management of these pathological entities. In addition, the role of exercise training and pulmonary rehabilitation programmes in the ILD population is addressed.

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“…Dumitrescu et al [22] studied parameters of cardiopulmonary exercise testing (CPET) in patients with scleroderma and found that a high V E /V CO 2 ratio and decreasing end-tidal partial pressure of CO 2 at anaerobic threshold (PET CO 2 ) identifies the presence of pulmonary vasculopathy. Armstrong et al [23] showed that CPET can help to detect PH in patients with interstitial lung disease.…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary Exercise Testing to Detect Chronic Thromboembolic Pulmonary Hypertension in Patients with Normal Echocardiography

Held

Grün²,

Holl³

et al. 2014

Respiration

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Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious complication of pulmonary embolism (PE). Taking into account the reported incidence of CTEPH after acute PE, the number of patients with undiagnosed CTEPH may be high. Objectives: We aimed to determine if cardiopulmonary exercise testing (CPET) could serve as complementary tool in the diagnosis of CTEPH and can detect CTEPH in patients with normal echocardiography. Methods: At diagnosis, we analyzed the data of CPET parameters in 42 patients with proven CTEPH and 51 controls, and evaluated the performance of two scores. Results: VE/VCO₂ slope, EQO₂, EQCO₂, P(A-a)O₂, end-tidal partial pressure of CO₂ at anaerobic threshold (PETCO₂) and capillary to end-tidal carbon dioxide gradient [P(c-ET)CO₂] were significantly different between patients with CTEPH and controls (p < 0.001). P(c-ET)CO₂ was the single parameter with the highest sensitivity (85.7%) and specificity (88.2%). A score combining VE/VCO₂ slope, P(A-a)O₂, P(c-ET)CO₂, PETCO₂ [4-parameter-CPET (4-P-CPET) score] reached a sensitivity of 83.3% and a specificity of 92.2% after cross-validation. In 42 patients with CTEPH, echocardiography identified PH in 29 patients (69%), but it was normal in 13 patients (31%). All patients with normal or unmeasurable right ventricular systolic pressure had a pathological CPET. Twelve of the 13 patients (92%) were detected by both CPET scores. Conclusion: CPET is a useful noninvasive diagnostic tool for the detection of CTEPH in patients with suspected PH but normal echocardiography. The 4-P-CPET score provides a high sensitivity with the highest specificity.

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Distinguishing Pulmonary Hypertension in Interstitial Lung Disease by Ventilation and Perfusion Defects Measured by Cardiopulmonary Exercise Testing

Cited by 16 publications

References 16 publications

Pulmonary vascular response patterns during exercise in interstitial lung disease

Pulmonary vascular response patterns during exercise in interstitial lung disease

Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing

Cardiopulmonary Exercise Testing to Detect Chronic Thromboembolic Pulmonary Hypertension in Patients with Normal Echocardiography

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