Efficacy of cardiac rehabilitation after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

Abstract

ObjectiveTo determine safety and efficacy of cardiac rehabilitation (CR) initiated immediately following balloon pulmonary angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) who presented with continuing exercise intolerance and symptoms on effort even after a course of BPA; 2–8 sessions/patient.MethodsForty-one consecutive patients with inoperable CTEPH who underwent their final BPA with improved resting mean pulmonary arterial pressure of 24.7±5.5 mm Hg and who suffered remaining exercise intolerance were prospectively studied. Participants were divided into two groups just after the final BPA (6.8±2.3 days): patients with (CR group, n=17) or without (non-CR group, n=24) participation in a 12-week CR of 1-week inhospital training followed by an 11-week outpatient programme. Cardiopulmonary exercise testing, haemodynamics, and quality of life (QOL) were assessed before and after CR.ResultsNo significant between-group differences were found for any baseline characteristics. At week 12, peak oxygen uptake (VO2), per cent predicted peak VO2 (70.7±9.4% to 78.2±12.8%, p<0.01), peak workload, and oxygen pulse significantly improved in the CR group compared with the non-CR group, with a tendency towards improvement in mental health-related QOL. Quadriceps strength and heart failure (HF) symptoms (WHO functional class, 2.2–1.8, p=0.01) significantly improved within the CR group. During the CR, no patient experienced adverse events or deterioration of right-sided HF or haemodynamics as confirmed via catheterisation.ConclusionsThe combination of BPA and subsequent CR is a new treatment strategy for inoperable CTEPH to improve exercise capacity to near-normal levels and HF symptoms, with a good safety profile.

ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension

“…Exercise training can lead to meaningful improvements in exercise capacity, muscular function, QoL and possibly right ventricular function and pulmonary haemodynamics [3]. Beneficial effects of exercise training have been shown in six randomised controlled trials [15,[22][23][24][25][26], three controlled trials [27][28][29], 10 prospective cohort studies [16][17][18][19][20][21][30][31][32][33][34][35], three case series [34][35][36], two retrospective cohort studies [37,38] and four meta-analyses [39][40][41] including one Cochrane review [42]. Beside the clinical effects, it has also been shown that exercise training may reduce inflammation and cell proliferation on a molecular level and may have a beneficial effect on the pulmonary vessels.…”

Exercise Training After Pulmonary Endarterectomy for Patients with Chronic Thromboembolic Pulmonary Hypertension

“…Pulmonary hypertension is a cause of reduced exercise capacity; it may precede overt manifest pulmonary hypertension and is associated with a decreased life expectancy [28]. However, exercise training has been shown to be safe in these patients [11][12][13][14][15][16][29][30][31], and European guidelines recommend its use in experienced centers for patients who are clinically stable, on optimal pharmacological treatment [17,19].…”

“…In the past, exercise was not recommended in patients with pulmonary artery hypertension, particularly in those with more advanced disease due to safety concerns [17]. Pulmonary hypertension is a cause of reduced exercise capacity; it may precede overt manifest pulmonary hypertension and is associated with a decreased life expectancy [28].…”

“…Exercise training is also reported to be safe and effective in improving exercise capacity and quality of life in patients with pulmonary artery hypertension including those with CTEPH [10][11][12][13][14][15][16]. The combination of balloon pulmonary angioplasty and subsequent exercise training has been shown to be useful for inoperable CTEPH in improving exercise capacity with a good safety profile [17]. However, data on the effects of exercise training in CTEPH patients after PEA are scant.…”

Pulmonary Rehabilitation in Patients With Pulmonary Hypertension

“…However, Fukui et al reported the efficacy of cardiac rehabilitation after BPA for CTEPH. 16 Importantly, the study rehabilitation protocol was initiated immediately after the final BPA. Moreover, no patient experienced adverse events or deterioration of right-sided heart failure or hemodynamics, as confirmed with catheterization.…”