scholarly journals Isolated Exercise-Induced Pulmonary Hypertension Associates with Higher Cardiovascular Risk in Scleroderma Patients

2020 ◽  
Vol 9 (6) ◽  
pp. 1910
Author(s):  
Rosalinda Madonna ◽  
Riccardo Morganti ◽  
Francesco Radico ◽  
Piergiusto Vitulli ◽  
Marco Mascellanti ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiovascular Risk ◽  
Risk Score ◽  
Exercise Test ◽  
Prognostic Significance ◽  
Cardiopulmonary Exercise Test ◽  
Right Atrial ◽  
Cardiopulmonary Exercise ◽  
Exercise Induced ◽  
Clinical Worsening

Background and Aim: Isolated exercise-induced pulmonary hypertension (ExPH) associates with cardiovascular (CV) events in patients with left heart disease. We investigated its prognostic significance in scleroderma patients at risk for pulmonary arterial hypertension (PAH). Methods: In 26 consecutive scleroderma female patients with either low (n = 13) or intermediate probability (n = 13) of pulmonary hypertension (PH) at rest, we evaluated, both at time 0 and 1 year, prognostic determinants of CV risk: onset or progression of heart failure/syncope; worsening of functional class; functional performance at the 6-minute walking test and at cardiopulmonary exercise test; right atrial area; and pericardial effusion. We assigned a severity score 1–3 to each prognostic determinant, derived an overall CV risk score, and its 0–1 year change. Isolated ExPH during the cardiopulmonary exercise test (CPET) was defined as absence of PH at rest, reduced peak VO2, VE/VCO2 >30 at anaerobic threshold, reduced O2 pulse, and ΔVO2/ΔW <9 mL/min/W. We then correlated ExPH at time 0 with clinical worsening (risk score increase >20% after 1 year). Results: ExPH was strongly associated with clinical worsening compared to patients without ExPH (p = 0.005). In patients without ExPH, none had > 20% increased CV risk score after 1 year. Conversely, about 50% of patients with ExPH had such an increase, suggesting a worsening of prognosis. Conclusions: Isolated ExPH associates with higher cardiovascular risk and thus clinical worsening in scleroderma patients. The assessment of ExPH by CPET can thus contribute to a better risk stratification and the planning of a more adequate follow-up.

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 &gt; 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 &lt; 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 &lt; 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.

Oxygen saturation

2021 ◽  
pp. 97-101
Author(s):  
William J.M. Kinnear ◽  
James H. Hull
Keyword(s):  
Oxygen Saturation ◽  
Vascular Disease ◽  
Exercise Test ◽  
Elite Athletes ◽  
Cardiopulmonary Exercise Test ◽  
Oxygen Desaturation ◽  
Pulmonary Vascular Disease ◽  
Cardiopulmonary Exercise ◽  
Ventilatory Capacity ◽  
Exercise Induced

This chapter describes how desaturation during a cardiopulmonary exercise test (CPET) is uncommon. A fall of more than 4% from resting values is considered abnormal. Oxygen desaturation is usually caused by lung or pulmonary vascular disease, reflecting ventilation–perfusion inequality or impaired diffusion. Occasionally, a right-to-left shunt will open up in the heart during exercise. Some elite athletes show exercise-induced arterial hypoxaemia, when the ability of their muscles to utilize oxygen cannot be met by the subject’s ventilatory capacity.

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 Determinants of Interindividual Variation in Exercise‐Induced Cardiac Troponin I Levels

2021 ◽  
Author(s):  
Magnus Bjørkavoll‐Bergseth ◽  
Christine Bjørkvik Erevik ◽  
Øyunn Kleiven ◽  
Thijs M. H. Eijsvogels ◽  
Øyvind Skadberg ◽  
...  
Keyword(s):  
Exercise Test ◽  
High Intensity ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiopulmonary Exercise Test ◽  
Cardiac Troponin I ◽  
Interindividual Variation ◽  
Cardiopulmonary Exercise ◽  
Link Type ◽  
Exercise Induced

Background Postexercise cardiac troponin levels show considerable interindividual variations. This study aimed to identify the major determinants of this postexercise variation in cardiac troponin I (cTnI) following 3 episodes of prolonged high‐intensity endurance exercise. Methods and Results Study subjects were recruited among prior participants in a study of recreational cyclists completing a 91‐km mountain bike race in either 2013 or 2014 (first race). In 2018, study participants completed a cardiopulmonary exercise test 2 to 3 weeks before renewed participation in the same race (second race). Blood was sampled before and at 3 and 24 hours following all exercises. Blood samples were analyzed using the same Abbot high‐sensitivity cTnI STAT assay. Fifty‐nine individuals (aged 50±9 years, 13 women) without cardiovascular disease were included. Troponin values were lowest before, highest at 3 hours, and declining at 24 hours. The largest cTnI difference was at 3 hours following exercise between the most (first race) (cTnI: 200 [87–300] ng/L) and the least strenuous exercise (cardiopulmonary exercise test) (cTnI: 12 [7–23] ng/L; P <0.001). The strongest correlation between troponin values at corresponding times was before exercise ( r =0.92, P <0.0001). The strongest correlations at 3 hours were between the 2 races ( r =0.72, P <0.001) and at 24 hours between the cardiopulmonary exercise test and the second race ( r =0.83, P <0.001). Participants with the highest or lowest cTnI levels showed no differences in race performance or baseline echocardiographic parameters. Conclusions The variation in exercise‐induced cTnI elevation is largely determined by a unique individual cTnI response that is dependent on the duration of high‐intensity exercise and the timing of cTnI sampling. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02166216 .

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

scholarly journals Cardiopulmonary exercise test and PaO2 in evaluation of pulmonary hypertension in COPD

2017 ◽  
Vol Volume 13 ◽  
pp. 91-100 ◽  
Author(s):  
Ingunn Skjørten ◽  
Janne Mykland Hilde ◽  
Morten Nissen Melsom ◽  
Jonny Hisdal ◽  
Viggo Hansteen ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Exercise Test ◽  
Cardiopulmonary Exercise Test ◽  
Cardiopulmonary Exercise
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