Pulmonary Circulation at Exercise

Naeije, Robert; Chesler, Naomi C.

doi:10.1002/cphy.c100091

Cited by 153 publications

(173 citation statements)

References 236 publications

(473 reference statements)

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“…Several studies have previously demonstrated that functional changes during exercise are adaptive if the ventricle is energetically efficient, which is usually observed with an Ees/Ea ratio of 1-2 [17,18]. Our findings are in accordance with studies showing that patients with PH have an impairment of power transfer and ventricular efficiency during exercise [11,19]. Among functional indices at rest, RVFAC showed the best correlation to ventriculararterial coupling and contractile reserve, indicating that, if reliably measured, it could be a useful parameter for outcome or for screening.…”

Section: Discussionsupporting

confidence: 92%

Right ventricular reserve in a piglet model of chronic pulmonary hypertension

et al. 2014

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Right ventricular (RV) response to exercise or pharmacological stress is not well documented in pulmonary hypertension (PH). We investigated the relationship between RV reserve and ventricular-arterial coupling.Surgical ligation of the left pulmonary artery was performed in 13 Large White piglets (PH group), thereafter weekly embolisations of the right lower lobe were performed for 5 weeks. A control group of six piglets underwent sham procedures. Right heart catheterisation and echocardiography were performed at week 6. Pressure-volume loops were recorded before and after dobutamine infusion.Induction of experimental PH resulted in a higher mean±SD pulmonary artery pressure (34±9 versus 14±2 mmHg; p<0.01) and in a lower ventricular-arterial coupling efficiency (0.66±0.18 versus 1.24±0.17; p<0.01) compared with controls at 6 weeks. Dobutamine-induced relative changes in RV stroke volume index (SVI) and end-systolic elastance were lower in the PH group (mean±SD 47±5% versus 20±5%, p<0.01, and 81±37% versus 32±14%, p<0.01, respectively). Change in SVI was strongly associated with resting ventricular-arterial coupling (R 2 =0.74; p<0.01). RV reserve was associated with ventricular-arterial coupling in a porcine model of chronic pressure overload. @ERSpublications Dobutamine testing in right ventricular pressure overload: a potentially useful method to assess contractile reserve

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Section: Discussionsupporting

confidence: 92%

Right ventricular reserve in a piglet model of chronic pulmonary hypertension

et al. 2014

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“…The same reasoning holds true for venous post-capillary PH where the dPAP-PAWP gradient is small [35,36]. However, hypoxia and pulmonary vascular diseases leading to precapillary PH may alter the validity of this assumption, with Pzf being significantly above PAWP, as demonstrated when studying either the pressure intercept of the mPAP-CO linear plots when flow is increased or the pulmonary artery pressure (PAP) decay curve after balloon occlusion [37][38][39][40][41][42]. In cases where Pzf is significantly higher than PAWP, the true PVR will be overestimated if one uses equation 1 [31].…”

Section: Pulmonary Vascular Resistancementioning

confidence: 92%

“…hindrance), adjustment for haematocrit (which is the main determinant of blood viscosity) might be desirable particularly when extremes of haematocrit levels are encountered [37]. Other conceptual limitations of the standard PVR equation include assumptions that blood behaves as a Newtonian fluid and that the arteries behave as rigid tubes while they are both collapsible and distensible.…”

Section: Pulmonary Vascular Resistancementioning

confidence: 99%

Pulmonary vascular resistance and compliance relationship in pulmonary hypertension

et al. 2015

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Right ventricular adaptation to the increased pulmonary arterial load is a key determinant of outcomes in pulmonary hypertension (PH). Pulmonary vascular resistance (PVR) and total arterial compliance (C) quantify resistive and elastic properties of pulmonary arteries that modulate the steady and pulsatile components of pulmonary arterial load, respectively. PVR is commonly calculated as transpulmonary pressure gradient over pulmonary flow and total arterial compliance as stroke volume over pulmonary arterial pulse pressure (SV/PApp). Assuming that there is an inverse, hyperbolic relationship between PVR and C, recent studies have popularised the concept that their product (RC-time of the pulmonary circulation, in seconds) is "constant" in health and diseases. However, emerging evidence suggests that this concept should be challenged, with shortened RC-times documented in post-capillary PH and normotensive subjects. Furthermore, reported RC-times in the literature have consistently demonstrated significant scatter around the mean. In precapillary PH, the true PVR can be overestimated if one uses the standard PVR equation because the zero-flow pressure may be significantly higher than pulmonary arterial wedge pressure. Furthermore, SV/PApp may also overestimate true C. Further studies are needed to clarify some of the inconsistencies of pulmonary RC-time, as this has major implications for our understanding of the arterial load in diseases of the pulmonary circulation. @ERSpublications Empiric estimates of pulmonary arterial load are prone to errors and may result in overestimation of RC-time

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“…The measurement of the pressure-flow behaviour of the pulmonary circulation during exercise by right heart catheterisation (RHC) continues to be of interest despite the invasive process involved [1,18,19]. It provides information which cannot be accurately acquired by other routes.…”

Section: Invasive Measurementmentioning

confidence: 99%

“…In health both mPAP and PAOP rise with exercise. The estimated range of normality for mPAP change on exercise is 0.5-3.0 mmHg.min.L −1 [20] whereas the normal range for PAOP change is less certain, one estimate being 0.3-1.93 mmHg.min.L −1 [19]. During supine exercise PVR falls slightly [21,22] and S v O2 falls from 75% at rest to 25% at maximal exercise [23].…”

Section: Invasive Measurementmentioning

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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Pulmonary Circulation at Exercise

Cited by 153 publications

References 236 publications

Right ventricular reserve in a piglet model of chronic pulmonary hypertension

Right ventricular reserve in a piglet model of chronic pulmonary hypertension

Pulmonary vascular resistance and compliance relationship in pulmonary hypertension

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

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