Excessive Ventilatory Response During Exercise in Patients With Non-Hypoxic Pulmonary Hypertension.

Mitani, Reo; Haraguchi, Masahiko; Takata, Satoru; Murata, Mariko; Dairaku, Yuka; Kimura, Masahiro; Harada, Masahiko; Tada, Takashi; Matsuda, Masako; Matsuzaki, Masunori

doi:10.1253/circj.66.453

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…Mitani et al [25] suggested that it is necessary – when performing a CPET in PAH patients – to observe not only VO2 or VCO2, but also Ve/VCO2, in order to prevent aggravation of the ventilation/perfusion inequality, which leads to exercise-induced hypoxemia. A higher VE/VCO2 ratio describes a greater ventilatory requirement for eliminating the CO2 produced by aerobic metabolism and defines a reduced ventilatory efficiency.…”

Section: Discussionmentioning

confidence: 99%

“…If a simple non-invasive measurement, such as the VE/VCO2 ratio, could be shown to be useful in evaluating pulmonary vascular disease, it might serve to supplement other methods currently used to monitor clinical course and treatment. At now, few studies have investigated the relationship between exercise capacity and VE/VCO2 slope in patients with PH [24,25]. …”

Section: Introductionmentioning

confidence: 99%

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Ventilatory efficiency testing as prognostic value in patients with pulmonary hypertension

et al. 2012

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BackgroundIncreased ventilatory response has been shown to have a high prognostic value in patients with chronic heart failure. Our aim was therefore to determine the ventilatory efficiency in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension by cardiopulmonary exercise testing (CPET) identifying PH-patients with increased risk for death within 24 months after evaluation.Methods116 patients (age: 64 ± 1 years) with a mean pulmonary arterial pressure of 35 ± 1 mmHg underwent CPET and right heart catheterization. During a follow-up of 24 months, we compared the initial characteristics of survivors (n = 87) with nonsurvivors (n = 29).ResultsSignificant differences (p ≤ 0.005) between survivors and nonsurvivors existed in ventilatory equivalents for oxygen (42.1 ± 2.1 versus 56.9 ± 2.6) and for carbon dioxide (Ve/VCO2) (47.5 ± 2.2 versus 64.4 ± 2.3). Patients with peak oxygen uptake ≤ 10.4 ml/min/kg had a 1.5-fold, Ve/VCO2 ≥ 55 a 7.8-fold, alveolar-arterial oxygen difference ≥ 55 mmHg a 2.9-fold, and with Ve/VCO2 slope ≥ 60 a 5.8-fold increased risk of mortality in the next 24 months.ConclusionsOur results demonstrate that abnormalities in exercise ventilation powerfully predict outcomes in PH. Consideration should be given to add clinical guidelines to reflect the prognostic importance of ventilatory efficiency parameters in addition to peak VO2.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ventilatory efficiency testing as prognostic value in patients with pulmonary hypertension

et al. 2012

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“…The minimum dataset collected during exercise includes V E , oxygen and carbon dioxide content of inspired and expired air, HR and oxygen saturation (S p O 2 ). With these measurements the characteristic pathophysiological response of PAH patients can be seen, i.e., profound exercise limitation marked by impairment of oxygen transport and inefficient gas exchange with very high ventilatory demand [77][78][79][80][81][82][83][84][85]. In an incremental CPET, the oxygen transport abnormality is reflected in a low VO 2 at anaerobic threshold, low VO 2 -workrate slope, low peak oxygen (O 2 ) pulse (defined as the ratio of peak VO 2 to peak HR) and a steep HR-VO 2 response, combined on occasions with a HR response which fails to reach predicted maximum.…”

Section: Cardiopulmonary Exercise Testingmentioning

confidence: 99%

The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension

Johnson

Thomson

2014

Diseases

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A culture of exercise testing is firmly embedded in the management of pulmonary arterial hypertension (PAH) but its clinical relevance and utility have recently been under some debate. The six minute walk test (6MWT) has been used as a primary outcome measure to enable the licensing of many of the medications used for this condition. Recent reviews have questioned the validity of this test as a surrogate of clinical outcomes. At the same time, other questions are emerging where exercise testing may be the solution. With the rise in understanding of genetic markers of idiopathic PAH (IPAH), the screening of an otherwise healthy population for incipient pulmonary hypertension (PH) will be required. The proliferation in treatment choices and identification of populations with PH where PAH treatment is not indicated, such as left heart and lung disease, requires more definitive differentiation from patients with PAH. There is a continuing question about the existence and clinical relevance of exercise induced PAH as a cause of unexplained dyspnoea and fatigue and as a latent phase of resting PH. This review presents a summary and critical analysis of the current role of exercise testing in PAH and speculates on future trends.

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“…Im Vergleich zwischen PHT-Patienten (n = 8) und solchen mit CHF bei Zustand nach Herzinfarkt (n = 38) wurde für die PHT-Patienten eine deutlich schlechtere Atemeffizienz bei vergleichbarer Peak-VO 2 nachgewiesen [33]. Mittels des zeitlichen Verhaltens unter Belastung (z.B.…”

Section: Belastungsuntersuchungenunclassified

Beurteilung der kardiopulmonalen Funktion und Belastungstests bei Patienten mit pulmonaler Hypertonie

Ewert

Opitz

Wensel

et al. 2005

Herz

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Pulmonary hypertension is diagnosed by various investigations that are essential for making the diagnosis. Following a careful history and physical examination, an electrocardiogram, a chest X-ray, lung function studies, blood tests and an echocardiogram form the basis of the diagnostic algorithm. Following these studies, a right and sometimes additional left heart catheterization are carried out to establish the diagnosis and to perform acute vasodilator testing. Most of these studies are performed at rest. However, exercise studies are an important part of the functional assessment in this group of patients. Exercise capacity can be estimated by functional class, measured with the 6-min walk test or comprehensively assessed by cardiopulmonary exercise testing with gas exchange analysis. Once the diagnosis and etiology of pulmonary hypertension have been established, several parameters can predict outcome in these patients: functional class, right ventricular function, pulmonary hemodynamics, and certain laboratory parameters (uric acid, brain natriuretic peptide, troponin, endothelin-1). In addition, exercise parameters such as walking distance, peak oxygen uptake or peak systolic blood pressure can reliably predict prognosis in these patients.

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Excessive Ventilatory Response During Exercise in Patients With Non-Hypoxic Pulmonary Hypertension.

Cited by 9 publications

References 21 publications

Ventilatory efficiency testing as prognostic value in patients with pulmonary hypertension

Ventilatory efficiency testing as prognostic value in patients with pulmonary hypertension

The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension

Beurteilung der kardiopulmonalen Funktion und Belastungstests bei Patienten mit pulmonaler Hypertonie

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