Exercise-Induced Pulmonary Artery Hypertension

Kiencke, Stephanie; Bernheim, Alain; Maggiorini, Marco; Fischler, Manuel; Aschkenasy, Schlomo V.; Dorschner, Lorenz; Debrunner, Johann; Bloch, Konrad E.; Mairbäurl, Heimo; Rocca, Hans Peter Brunner–La

doi:10.1016/j.jacc.2007.10.018

Cited by 10 publications

(7 citation statements)

References 6 publications

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“…A number of investigators have reported subsets of patients with pathologic sPAP responses during exercise and normal sPAP at rest; this is referred to as exercise‐induced PH (Table ) . Recently, using invasive maximum cardiopulmonary exercise testing, Tolle et al .…”

Section: Latent Ph: How To Challenge the Cardiopulmonary System?mentioning

confidence: 99%

“…55 A number of investigators have reported subsets of patients with pathologic sPAP responses during exercise and normal sPAP at rest; this is referred to as exercise-induced PH (Table III). [54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] Recently, using invasive maximum cardiopulmonary exercise testing, Tolle et al 69 phenotyped a large cohort of patients with exercise-induced PAH. In particular, they showed that at maximum exercise, oxygen uptake was lowest in resting PAH, intermediate in exercise-induced PAH, and highest in normal subjects, whereas mPAP and PVR followed the opposite pattern.…”

Section: Pulmonary Hemodynamicsmentioning

confidence: 99%

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Pulmonary Arterial Hypertension: The Key Role of Echocardiography

et al. 2014

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Echocardiography is a key screening tool in the diagnostic algorithm of pulmonary arterial hypertension (PAH). It provides an estimate of right ventricular function and pulmonary artery pressure, either at rest or during exercise, and is useful in ruling out secondary causes of pulmonary hypertension (PH) such as left heart disease or congenital heart disease. Several studies have showed that echocardiography is insufficiently precise as single tool for the ultimate diagnosis of PH respect to the right heart catheterization, considered the gold standard technique. Echocardiography is valuable in assessing prognosis and treatment options, monitoring the efficacy of specific therapeutic interventions, and detecting the preclinical stages of disease. The ideal imaging modality for accurate noninvasive assessment of the right heart should be accurate and precise, not influenced by loading conditions, routinely practicable and easily repeatable. For all such reasons and considering that PAH is a rare and severe condition, a complete noninvasive assessment of right heart function requires a deep knowledge of the disease and a multimodality approach.

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Section: Latent Ph: How To Challenge the Cardiopulmonary System?mentioning

confidence: 99%

Section: Pulmonary Hemodynamicsmentioning

confidence: 99%

Pulmonary Arterial Hypertension: The Key Role of Echocardiography

et al. 2014

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“…Similarly, PAP measured only at rest fails to detect a significant percentage of patients with exercise‐induced PAH (EIPAH). EIPAH is a poorly understood entity 4–12. Some believe that EIPAH is an early and more treatable phase that precedes resting PAH, whereas others suggest that it may be a stable variant of the disease 5,6,13–15.…”

Section: Introductionmentioning

confidence: 99%

Detection of Exercise‐Induced Pulmonary Arterial Hypertension by Cardiopulmonary Exercise Testing

Schwaiblmair¹,

Faul²,

Scheidt³

et al. 2012

Clinical Cardiology

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Background: The pulmonary arterial pressure (PAP) response to exercise may provide a tool for the early detection of pulmonary arterial hypertension (PAH). Therefore, an accurate noninvasive method for evaluating exercise-induced PAH (EIPAH) is desirable. Hypothesis: We sought to examine if cardiopulmonary exercise testing (CPET) is able to indicate EIPAH. Methods: Fifty-three patients aged 67.1 ± 1.7 years (37 female, 16 male) with borderline PAH (resting mean PAP 21-24 mm Hg) performed CPET and right heart catheterization at rest and during handgrip testing. Results: When comparing patients with an exercise-induced mean PAP ≥35 mm Hg (group A, n = 24) and subjects with an exercise-induced mean PAP <35 mm Hg (group B, n = 29), group A had a significantly lower mean aerobic capacity (15.2 ± 1.2 vs 19.7 ± 1.2 mL/min/kg; P = 0.02), higher ventilatory equivalents for oxygen at the anaerobic threshold (34.3 ± 1.5 vs 29.9 ± 1.1; P = 0.02), a widening of the mean alveolararterial oxygen difference (37.8 ± 3.0 vs 26.8 ± 2.4 mm Hg; P = 0.007), an elevated mean functional dead space ventilation (29.5 ± 2.7 vs 21.2 ± 1.7%; P = 0.008), and a higher mean arterial to end-tidal carbon dioxide gradient at peak exercise (3.7 ± 0.9 vs 0.4 ± 0.8 mm Hg; P = 0.007). Conclusions: EIPAH is characterized by a decreased ventilatory efficiency due to ventilation to perfusion inequalities. CPET may be useful for the identification of EIPAH and serve to diagnose PAH at an early stage.

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“…[25][26][27][28][29][30][31][32][33][34][35][36][37] Grü nig and colleagues 27 implemented systolic PAP calculated from the maximum velocity of tricuspid regurgitation (TR) to detect abnormal pulmonary vascular responses to exercise in 9 subjects with a history of previous highaltitude pulmonary edema (HAPE), known to be associated with excessive increases in PAP when challenged with hypoxic breathing or exercise. Only the subjects with a previous HAPE, and none of the controls, presented with a systolic PAP higher than 40 mm Hg at exercise.…”

Section: Exercise Stress Tests For the Detection Of Early Or Latent Pmentioning

confidence: 99%