Impaired cardiac autonomic control relates to disease severity in pulmonary hypertension

Wensel, Roland; Jilek, Clemens; Dörr, Marcus; Francis, Dárrel P.; Stadler, H; Lange, Tobias; Blumberg, Friedrich C.; Opitz, Christian; Pfeifer, Michael; Ewert, Ralf

doi:10.1183/09031936.00145708

Cited by 134 publications

(125 citation statements)

References 37 publications

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“…Ventilation was slightly increased in CTEPH at rest and during exercise (15 (4-21) versus 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) and 58 (29-78) versus 50 (29-82) L?min -1 ), but with no significant difference between the two groups. There were no significant differences between CTEPH and IPAH in oxygen uptake upon maximal exercise (table 3), and tidal volume at rest and at maximal exercise (0.7 (0.4-1.3) versus 0.7 (0.5-1.4) and 1.9 (0.7-2.3) versus 1.9 (1.3-3.1) L, respectively).…”

Section: Discussionmentioning

confidence: 92%

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Diagnosis of CTEPH versus IPAH using capillary to end-tidal carbon dioxide gradients

Englisch²,

Kovàcs³

et al. 2011

European Respiratory Journal

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Chronic thromboembolic pulmonary hypertension (CTEPH) represents an important differential diagnosis to idiopathic pulmonary arterial hypertension (IPAH). We hypothesised that the capillary to end-tidal carbon dioxide gradient at rest and during exercise might help differentiate CTEPH from IPAH.Patients who presented with unequivocal IPAH or CTEPH according to ventilation/perfusion scanning, pulmonary angiography, computed tomography and right heart catheterisation were included in this retrospective study and compared with healthy controls.21 IPAH patients and 16 CTEPH patients fulfilled the inclusion criteria. Haemodynamics and peak oxygen uptake were comparable, but respiratory rates at rest and during exercise were significantly higher in CTEPH than in IPAH. End-tidal carbon dioxide was significantly lower in CTEPH versus IPAH at rest and during exercise, while capillary carbon dioxide values were similar. Correspondingly, capillary to end-tidal carbon dioxide gradients were significantly increased in CTEPH versus IPAH at rest and during exercise (median (range) 8.6 (3.0-13.7) versus 4.4 (0.9-9.0) (p,0.001) and 9.3 (3.3-13.1) versus 4.1 (0.0-8.8) mmHg (p,0.001), respectively). Although these values were closer to normal in IPAH they were still significantly elevated compared with healthy controls (2.3 (-4.8-8.1) and -1.9 (-5.7-6.2) mmHg, respectively).Capillary to end-tidal carbon dioxide gradients may help to distinguish CTEPH from IPAH based on resting and exercise values.

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Section: Discussionmentioning

confidence: 92%

“…Ventilatory inefficiency in PAH and CTEPH is associated with hyperventilation. This may be due to increased chemosensitivity [18] or an augmented dead space fraction [19]. ZHAI et al [19] investigated ventilatory efficiency by comparing physiological dead space fraction and EQCO 2 in PAH and CTEPH patients.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of CTEPH versus IPAH using capillary to end-tidal carbon dioxide gradients

Englisch²,

Kovàcs³

et al. 2011

European Respiratory Journal

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“…It is known that these systems are activated in right HF as well (202). For example, it has been observed that plasma epinephrine levels were elevated, beta-1 adrenergic receptors were "downregulated" in RV and heart rate variation was reduced in right HF (203)(204)(205)(206). There are also trials demonstrating that RAAS is similarly activated (207,208).…”

Section: Do Beta-blockers or Digoxin Affect Ph Associated With Left Hmentioning

confidence: 93%

Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice

Çavuşoğlu

Altay²,

Ekmekçi³

et al. 2015

Anatol J Cardiol

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Practical approaches for the treatment of chronic heart failure:Frequently asked questions, overlooked points and controversial issues in current clinical practiceHeart failure (HF) is a progressive disorder associated with impaired quality of life, high morbidity, mortality and frequent hospitalization and affects millions of people from all around the world. Despite further improvements in HF therapy, mortality and morbidity remains to be very high. The life-long treatment, frequent hospitalization, and sophisticated and very expensive device therapies for HF also leads a substantial economic burden on the health care system. Therefore, implementation of evidence-based guideline-recommended therapy is very important to overcome its worse clinical outcomes. However, HF therapy is a long process that has many drawbacks and sometimes HF guidelines cannot answers to every question which rises in everyday clinical practice. In this paper, commonly encountered questions, overlooked points, controversial issues, management strategies in grey zone and problems arising during follow up of a HF patient in real life clinical practice have been addressed in the form of expert opinions based on the available data in the literature. (Anatol J Cardiol 2015: 15 Suppl 2; 1-60)

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“…It has been shown that, as in left heart disease, patients with PAH have altered autonomic nervous system activity, the degree of which may reflect disease severity [152]. Such abnormalities may be visible in heart rate response during recovery from exercise and readily measured in variables such as HRR1, which is the fall in HR during the first minute of recovery.…”

Section: Field Exercise Testsmentioning

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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Impaired cardiac autonomic control relates to disease severity in pulmonary hypertension

Cited by 134 publications

References 37 publications

Diagnosis of CTEPH versus IPAH using capillary to end-tidal carbon dioxide gradients

Diagnosis of CTEPH versus IPAH using capillary to end-tidal carbon dioxide gradients

Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice

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

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