scholarly journals Cardiopulmonary exercise test could predict residual pulmonary hypertension after pulmonary endarterectomy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.L Coronel ◽  
A Flox Camacho ◽  
T Segura De La Cal ◽  
C Perez Olivares Delgado ◽  
M.J Cristo Ropero ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Exercise Test ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Cardiopulmonary Exercise Test ◽  
Functional Class ◽  
Functional Improvement ◽  
Invasive Technique ◽  
Pulmonary Endarterectomy ◽  
Cardiopulmonary Exercise ◽  
Residual Pulmonary Hypertension

Abstract Introduction Pathophysiology of chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by thrombotic lesions at pulmonary arteries and arteriolar remodeling in distal regions. There is an increase in pulmonary vascular resistance that will lead to heart failure and early death without treatment. Currently, pulmonary endarterectomy (PE) is the potentially curative treatment for this condition. Cardiopulmonary exercise test (CPET) allows to quantify functional improvement after PE. Objective: To analyze changes in CPET and hemodynamic parameters after surgery in a cohort of patients with CTEPH. Methods 502 patients with CTEPH have been evaluated until December 2018, PE was performed in 255 (51%). In 49 patients, CPET was available before and 6 months after surgery. Residual pulmonary hypertension (RPH) was defined as mean pulmonary arterial pressure ≥30 mmHg evaluated by right cardiac catheterization at 3–6 months after PE. Results 54% were men, mean age 48±13 years. Two thirds of patients were in functional class II/III at time of diagnosis and with severe hemodynamic and functional profile. Hemodynamics and CPET parameters improved after surgery. However, in patients with RPH they did not improve significantly. Results are shown in table. Conclusions PE restores functional capacity in CTEPH, represented by significant improvement in CPET parameters. CPET is emerging as a non-invasive technique suitable of detecting RPH. More studies are needed to confirm this hypothesis. Funding Acknowledgement Type of funding source: None

scholarly journals 587 Exercise induced pulmonary hypertension in hypertrophic cardiomyopathy: a combined cardiopulmonary exercise test-echocardiographic study

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Federica Re ◽  
Geza Halasz ◽  
Francesco Moroni ◽  
Matteo Beltrami ◽  
Pasquale Baratta ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Hypertrophic Cardiomyopathy ◽  
Exercise Test ◽  
Functional Limitation ◽  
Prognostic Significance ◽  
Cardiopulmonary Exercise Test ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Cardiopulmonary Exercise ◽  
Exercise Induced

Abstract Aims Pulmonary arterial hypertension (PAH) has been described in patients with hypertrophic cardiomyopathy (HCM) and it was associated with a worse prognosis. Nevertheless in most HCM patients, despite normal pulmonary pressures at rest, congestive symptoms are elicited by exercise. In the present study, combining cardiopulmonary exercise test (CPET) with echocardiography, we aimed to evaluate the presence of exercise-induced pulmonary hypertension (EiPAH) its role in functional limitation and its prognostic significance in a cohort of patients with obstructive and non-obstructive HCM. Methods and results 182 HCM patients (35% females, mean age 47.5 ± 15.9) undergoing CPET. During CPET, LVOT velocities and trans-tricuspid gradient were measured. Thirty-seven patients (20%) developed sPAP > 40 mmHg at peak exercise (EiPAH). EiPAH was associated with an lower exercise performance, larger left atrial volumes, higher left ventricular gradient and higher VE/VCO2 slope .At multivariable model baseline sPAP (P < 0.0001) and baseline left ventricular obstruction (LVOT) (P = 0.028) were significantly associated with EiPAH .Kaplan-Meier curve analysis showed EiPAH was a significant predictor of HCM –related morbidity (hazards ratio: 6.21, 95% CI: 1.47–26.19; P = 0.05; 4.21, 95% CI: 1.94–9.12; P < 0.001) for the primary and the secondary endpoint respectively. Conclusions EiPAH was present in about one fifth of HCM patients without evidence of elevated pulmonary pressures at rest, and was associated with adverse clinical outcome. Diagnosing EiPAH by exercise echo/CPET may help physicians to detect early stage of PAH requiring a closer clinical monitoring and individualized treatment strategies.

scholarly journals Pulmonary Endarterectomy in Latvia: A National Experience

Medicina ◽  
2019 ◽  
Vol 55 (1) ◽  
pp. 18
Author(s):  
Matiss Sablinskis ◽  
Kristaps Sablinskis ◽  
Andris Skride
Keyword(s):  
New York ◽  
Pulmonary Hypertension ◽  
Treatment Options ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Heart Association ◽  
Functional Class ◽  
Pulmonary Endarterectomy ◽  
Hemodynamic State ◽  
Test Distance ◽  
And Shifts

Background and objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a hemodynamic state characterized by chronic obstruction in pulmonary circulation. The treatment of choice is pulmonary endarterectomy (PEA). The aim of our study was to compile and analyze the data of a small, national center, which has not yet been done in the Baltic states. Materials and methods: The data of Latvian CTEPH registry in timeframe from 1 September 2007 to 31 December 2016 was retrospectively analyzed and all patients who underwent PEA were included. Results: PEA was done for 7 patients. The in-hospital mortality was 14%. The 3-year survival rate was 86%. The procedure restored pulmonary blood pressure to normal values for three of the patients (42%). The remaining four patients (57%) had persistent pulmonary hypertension (mPAP > 30 mmHg), which required continuous therapy. There was a comparable decline in mean mPAP compared to baseline, 53.4 ± 14.4 mmHg to 44.3 ± 30 mmHg, respectively. At 12-month follow-up, there was a significant improvement in functional capacity, as seen by increased 6-min walk test distance and shifts in New York Heart Association functional class. Conclusions: Only 16% of all prevalent Latvian CTEPH patients have underwent PEA in the course of nine years, despite it being the treatment of choice for CTEPH. As PEA and other emerging treatment options, such as balloon pulmonary angioplasty, can only be done in expert centers, numerous organizational, logistical, and economic issues arise for patients of smaller countries, where such centers have not yet been created due to lack of experience and limited amount of patients.

scholarly journals The extent of enlarged bronchial arteries is not correlated with the development of reperfusion pulmonary edema after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension

2020 ◽  
Vol 10 (4) ◽  
pp. 204589402096867
Author(s):  
Yumiko Ikubo ◽  
Takayuki J. Sanada ◽  
Nobuhiro Tanabe ◽  
Akira Naito ◽  
Hiroki Shoji ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Edema ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Endarterectomy ◽  
Bronchial Arteries ◽  
Thromboembolic Pulmonary Hypertension ◽  
Residual Pulmonary Hypertension

This study investigated whether dilated bronchial arteries are associated with reperfusion pulmonary edema in patients with chronic thromboembolic pulmonary hypertension. Results showed that the extent of enlarged bronchial arteries was not associated with the development of reperfusion pulmonary edema, whereas the residual pulmonary hypertension had a significant association.

scholarly journals CAMPHOR score: patient-reported outcomes are improved by pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension

2020 ◽  
Vol 56 (4) ◽  
pp. 1902096
Author(s):  
Michael Newnham ◽  
Katherine Bunclark ◽  
Nisha Abraham ◽  
Samantha Ali ◽  
Liliana Amaral-Almeida ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Patient Reported Outcome ◽  
Pulmonary Endarterectomy ◽  
Minimally Clinically Important Difference ◽  
Recommended Treatment ◽  
Patient Reported ◽  
Thromboembolic Pulmonary Hypertension ◽  
Clinically Significant ◽  
Residual Pulmonary Hypertension

BackgroundPulmonary endarterectomy (PEA) is the recommended treatment for eligible patients with chronic thromboembolic pulmonary hypertension (CTEPH). The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) score is an internationally validated patient-reported outcome (PRO) measure for CTEPH. It assesses three domains: activity, quality of life (QoL) and symptoms. We assessed PROs in patients with CTEPH undergoing PEA.MethodsThis retrospective observational study of consecutive CTEPH patients undergoing PEA at the UK national PEA centre between 2006 and 2017 assessed change in CAMPHOR score from baseline (pre-PEA) until up to 5 years post-PEA. CAMPHOR scores were compared between 1) those with and without clinically significant residual pulmonary hypertension and 2) those undergoing PEA and propensity-matched CTEPH patients who were not operated on. The minimally clinically important difference (MCID) was calculated using an anchor-based method.ResultsOut of 1324 CTEPH patients who underwent PEA, 1053 (80%) had a CAMPHOR score recorded pre-PEA, 934 (71%) had a score recorded within a year of PEA and 784 (60%) had both. There were significant improvements between pre- and post-PEA in all three CAMPHOR domains (median±interquartile range activity −5±7, QoL −4±8, symptoms −7±8; all p<0.0001). Improvements in CAMPHOR score were greater and more sustained in those without clinically significant residual pulmonary hypertension. CTEPH patients undergoing PEA had better CAMPHOR scores than those not operated on. The MCID in CAMPHOR score was −3±5 for activity, −4±7 for QoL and −6±7 for symptoms.ConclusionsPROs are markedly improved by PEA in patients with CTEPH, more so in those without clinically significant residual pulmonary hypertension.

A thousand words about the cardiopulmonary exercise test in respiratory system diseases

2019 ◽  
Vol 88 (2) ◽  
pp. 117-122
Author(s):  
Jacek Tarchalski ◽  
Tomasz Piorunek ◽  
Przemysław Guzik
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Disease ◽  
Respiratory System ◽  
Exercise Test ◽  
Lung Diseases ◽  
Cardiopulmonary Exercise Test ◽  
Cycle Ergometer ◽  
Interstitial Lung Diseases ◽  
Physiological Variables ◽  
Cardiopulmonary Exercise

The cardiopulmonary exercise test (CPET) is designed to measure some physiological variables related to the function of the cardiovascular and respiratory systems during exercise. Usually, the CPET is performed either on a treadmill or a cycle ergometer. In this mini‑review, we describe a set of parameters which are most commonly used to quantify CPET. We also summarize clinical indications for this test and interpretation of the obtained results in patients with respiratory system diseases. The CPET, if made appropriately, may deliver valuable information helpful in the diagnosis, e.g., of unexplained dyspnea, and prognosis, e.g., in chronic obturatory pulmonary disease, pulmonary hypertension, or interstitial lung diseases.

The Effect of Pulmonary Hypertension on Cardiopulmonary Exercise Test in Severe COP

CHEST Journal ◽  
2012 ◽  
Vol 142 (4) ◽  
pp. 737A
Author(s):  
Wilawan Thirapatarapong ◽  
Hilary Armstrong ◽  
Matthew Bartels
Keyword(s):  
Pulmonary Hypertension ◽  
Exercise Test ◽  
Cardiopulmonary Exercise Test ◽  
Cardiopulmonary Exercise
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