Readdressing the entity of exercise pulmonary arterial hypertension

Abstract

Exercise pulmonary hypertension (EPH) indicates an abnormally elevated pulmonary artery pressure (PAP) during exercise. The physiological range of PAP during exercise remains poorly defined and, therefore, a universally accepted definition of EPH remains elusive. Nevertheless, previous data concerning the distribution of PAP in normal populations and more recent retrospective clinical data enhanced our ability to define EPH. EPH can impair exercise capacity and cause dyspnea. The underlying pathophysiology of the arterial form of EPH (EPAH) appears to be similar to that seen in resting pulmonary arterial hypertension (PAH), and EPAH individuals are at risk of developing resting PAH. Patients with collagen vascular disease, especially scleroderma, are at risk for EPAH and its presence indicates a relatively poor prognosis. The prevalence of EPAH in scleroderma may be as high as 50%. The utility of pulmonary vasodilator therapy for EPAH is not well defined; however, a sizable subgroup of EPAH patients will achieve an improvement in symptoms.

Floating the invisible swan: noninvasive prediction of haemodynamics

“…Recent studies have identified RA dysfunction as both prevalent and prognostically important in patients with World Health Organization (WHO) group 1 PH [17]. However, detailed pathophysiological study of exercise-induced PH has been hampered by the lack of consensus regarding thresholds for diagnosis, the variability in protocols utilised for exercise, and the invasive nature of the study required for diagnosis [18]. Although OBOKATA et al [14] contribute to the known literature by showing similar abnormalities in the RA in their subset of patients highly enriched for WHO group 2 PH, the broadly generalisability of this finding to all subsets of patients with either exercise-induced or resting PH remains unclear.…”

Vital capacity and valvular dysfunction could serve as non-invasive predictors to screen for exercise pulmonary hypertension in the elderly based on a new diagnostic score

“…7 Pre-emptive measures are required to detect this condition, raising the question of whether early treatment could provide clinical benefit as recently shown in a small cohort of patients. [8][9][10][11] However, before standardised treatment can be initiated, a precise and reliable definition of exPH is needed, since it seems to be a unique pathological entity, with patients displaying different alterations in biochemical pathways than resting PH patients and healthy controls. 12,13 Additionally, the kinetics of hemodynamic recovery seem to vary between different types of PH and exPH.…”

Daily Chronic Intermittent Hypobaric Hypoxia Does Not Induce Chronic Increase in Pulmonary Arterial Pressure Assessed by Echocardiography

“…Yet, this increase is moderate in healthy subjects even under maximal exercise, because vasodilation and vascular recruitment are decreasing pulmonary vascular resistance (PVR) at the same time. A disproportionately high rise in PAP under exertion is considered a sign of early stages of pulmonary vascular remodeling and disease [ 12 ]. At altitude, PAP rises more sharply with the increase in CO upon exercise compared to sea level [ 13 ].…”