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Wang H, Li W, Yan Y, Shi MJ, Hou F, Zhang RP. Sildenafil improves hemodynamic changes caused by acute pulmonary embolism by inhibiting Rho kinase activity. J Int Med Res 2024; 52:3000605241240938. [PMID: 38603613 PMCID: PMC11010764 DOI: 10.1177/03000605241240938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/04/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE This study examined the effects of sildenafil on acute pulmonary embolism (APE) using a rat model. METHODS Sprague-Dawley rats were randomly divided into the sham, pulmonary thromboembolism (PTE), and sildenafil groups. The sham and PTE groups received normal saline once daily via gavage for 14 consecutive days, whereas the sildenafil group received sildenafil (0.5 mg/kg/day) once daily via gavage for 14 consecutive days. Autologous emboli were prepared from blood samples collected from the left femoral artery of rats in each group on day 13, and autologous emboli were injected into the jugular vein cannula of rats in the PTE and sildenafil groups on day 14. Sham-treated rats received the same volume of saline. Right systolic ventricular pressure (RVSP) and mean pulmonary arterial pressure (MPAP) were used to assess pulmonary embolism, and western blotting and enzyme-linked immunosorbent assay were used to detect relevant markers. RESULTS The Rho kinase signaling pathway was significantly activated in rats with APE, and sildenafil significantly inhibited this activation. CONCLUSIONS Sildenafil protected against APE through inhibiting Rho kinase activity, thereby reducing pulmonary vasoconstriction and decreasing elevated pulmonary arterial pressure. These findings might provide new ideas for the clinical treatment of acute pulmonary thromboembolism.
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Affiliation(s)
- Hui Wang
- Department of Vascular Surgery, Shaanxi Provincial People’s Hospital
| | - Wei Li
- Department of Vascular Surgery, Shaanxi Provincial People’s Hospital
| | - Yan Yan
- Department of Vascular Surgery, Shaanxi Provincial People’s Hospital
| | - Meng-Jie Shi
- Department of Vascular Surgery, Shaanxi Provincial People’s Hospital
| | - Feng Hou
- Department of Vascular Surgery, Shaanxi Provincial People’s Hospital
| | - Rui-Peng Zhang
- Department of Vascular Surgery, Shaanxi Provincial People’s Hospital
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2
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Pezzuto B, Agostoni P. The Current Role of Cardiopulmonary Exercise Test in the Diagnosis and Management of Pulmonary Hypertension. J Clin Med 2023; 12:5465. [PMID: 37685532 PMCID: PMC10487723 DOI: 10.3390/jcm12175465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease with a poor prognosis if left untreated. Despite remarkable achievements in understanding disease pathophysiology, specific treatments, and therapeutic strategies, we are still far from a definitive cure for the disease, and numerous evidences have underlined the importance of early diagnosis and treatment to improve the prognosis. Cardiopulmonary exercise testing (CPET) is the gold standard for assessing functional capacity and evaluating the pathophysiological mechanisms underlying exercise limitation. As effort dyspnea is the earliest and one of the main clinical manifestations of PAH, CPET has been shown to provide valid support in early detection, differential diagnosis, and prognostic stratification of PAH patients, being a useful tool in both the first approach to patients and follow-up. The purpose of this review is to present the current applications of CPET in pulmonary hypertension and to propose possible future utilization to be further investigated.
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Affiliation(s)
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy;
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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3
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Neder JA, Phillips DB, O'Donnell DE, Dempsey JA. Excess ventilation and exertional dyspnoea in heart failure and pulmonary hypertension. Eur Respir J 2022; 60:13993003.00144-2022. [PMID: 35618273 DOI: 10.1183/13993003.00144-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/05/2022] [Indexed: 01/11/2023]
Abstract
Increased ventilation relative to metabolic demands, indicating alveolar hyperventilation and/or increased physiological dead space (excess ventilation), is a key cause of exertional dyspnoea. Excess ventilation has assumed a prominent role in the functional assessment of patients with heart failure (HF) with reduced (HFrEF) or preserved (HFpEF) ejection fraction, pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). We herein provide the key pieces of information to the caring physician to 1) gain unique insights into the seeds of patients' shortness of breath and 2) develop a rationale for therapeutically lessening excess ventilation to mitigate this distressing symptom. Reduced bulk oxygen transfer induced by cardiac output limitation and/or right ventricle-pulmonary arterial uncoupling increase neurochemical afferent stimulation and (largely chemo-) receptor sensitivity, leading to alveolar hyperventilation in HFrEF, PAH and small-vessel, distal CTEPH. As such, interventions geared to improve central haemodynamics and/or reduce chemosensitivity have been particularly effective in lessening their excess ventilation. In contrast, 1) high filling pressures in HFpEF and 2) impaired lung perfusion leading to ventilation/perfusion mismatch in proximal CTEPH conspire to increase physiological dead space. Accordingly, 1) decreasing pulmonary capillary pressures and 2) mechanically unclogging larger pulmonary vessels (pulmonary endarterectomy and balloon pulmonary angioplasty) have been associated with larger decrements in excess ventilation. Exercise training has a strong beneficial effect across diseases. Addressing some major unanswered questions on the link of excess ventilation with exertional dyspnoea under the modulating influence of pharmacological and nonpharmacological interventions might prove instrumental to alleviate the devastating consequences of these prevalent diseases.
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Affiliation(s)
- J Alberto Neder
- Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Dept of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Devin B Phillips
- Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Dept of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Denis E O'Donnell
- Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Dept of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Jerome A Dempsey
- John Rankin Laboratory of Pulmonary Medicine, Dept of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
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Broadman J, Jensen D. Effect of induced acute metabolic alkalosis on the V̇ E/V̇CO 2 response to exercise in healthy adults. Respir Physiol Neurobiol 2021; 294:103740. [PMID: 34256173 DOI: 10.1016/j.resp.2021.103740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/27/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
We tested the hypothesis that increasing the respiratory control systems' arterial PCO2 equilibrium point via induced acute metabolic alkalosis by ingestion of sodium bicarbonate (NaHCO3, 0.3 g/kg) would decrease the ventilatory equivalent for CO2 (V̇E/V̇CO2) at its lowest point ("nadir") during constant-load cycle exercise testing performed at 80 % of peak power output in 18 healthy young adults. Compared to the sodium chloride (4 g) control condition, ingestion of NaHCO3: increased arterialized venous pH, HCO3- and PCO2 at rest by 0.05 ± 0.01 units (mean ± SE), 6.4 ± 0.4 mEq/L and 4.3 ± 0.7 mmHg, respectively (all p < 0.0001); and decreased the V̇E/V̇CO2 nadir during exercise by 9.4 % (p < 0.0001) secondary to a 4.7 ± 1.8 L/min decrease in V̇E (p = 0.019). In conclusion, induced acute metabolic alkalosis by ingestion of NaHCO3 decreased the V̇E/V̇CO2 response to strenuous exercise in healthy adults.
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Affiliation(s)
- Joshua Broadman
- Clinical Exercise & Respiratory Physiology Laboratory, Department of Kinesiology & Physical Education, McGill University, Montreal, Quebec, Canada.
| | - Dennis Jensen
- Clinical Exercise & Respiratory Physiology Laboratory, Department of Kinesiology & Physical Education, McGill University, Montreal, Quebec, Canada; Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
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Serra-Payá N, Garnacho-Castaño MV, Sánchez-Nuño S, Albesa-Albiol L, Girabent-Farrés M, Moizé Arcone L, Fernández AP, García-Fresneda A, Castizo-Olier J, Viñals X, Molina-Raya L, Gomis Bataller M. The Relationship between Resistance Exercise Performance and Ventilatory Efficiency after Beetroot Juice Intake in Well-Trained Athletes. Nutrients 2021; 13:1094. [PMID: 33801665 PMCID: PMC8065812 DOI: 10.3390/nu13041094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
The assessment of ventilatory efficiency is critical to understanding the matching of ventilation (VE) and perfusion in the lungs during exercise. This study aimed to establish a causal physiological relationship between ventilatory efficiency and resistance exercise performance after beetroot juice (BJ) intake. Eleven well-trained males performed a resistance exercise test after drinking 140 mL of BJ (~12.8 mmol NO3-) or a placebo (PL). Ventilatory efficiency was assessed by the VE•VCO2-1 slope, the oxygen uptake efficiency slope and the partial pressure of end-tidal carbon dioxide (PetCO2). The two experimental conditions were controlled using a randomized, double-blind crossover design. The resistance exercise test involved repeating the same routine twice, which consisted of wall ball shots plus a full squat (FS) with a 3 min rest or without a rest between the two exercises. A higher weight lifted was detected in the FS exercise after BJ intake compared with the PL during the first routine (p = 0.004). BJ improved the VE•VCO2-1 slope and the PetCO2 during the FS exercise in the first routine and at rest (p < 0.05). BJ intake improved the VE•VCO2-1 slope and the PetCO2 coinciding with the resistance exercise performance. The ergogenic effect of BJ could be induced under aerobic conditions at rest.
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Affiliation(s)
- Noemí Serra-Payá
- School of Health Sciences, TecnoCampus Pompeu Fabra University, Ernest Lluch, 32 (Porta Laietana), 08302 Mataró-Barcelona, Spain; (N.S.-P.); (S.S.-N.); (L.A.-A.); (M.G.-F.); (L.M.A.); (A.P.F.); (A.G.-F.); (J.C.-O.); (X.V.); (M.G.B.)
| | - Manuel Vicente Garnacho-Castaño
- School of Health Sciences, TecnoCampus Pompeu Fabra University, Ernest Lluch, 32 (Porta Laietana), 08302 Mataró-Barcelona, Spain; (N.S.-P.); (S.S.-N.); (L.A.-A.); (M.G.-F.); (L.M.A.); (A.P.F.); (A.G.-F.); (J.C.-O.); (X.V.); (M.G.B.)
| | - Sergio Sánchez-Nuño
- School of Health Sciences, TecnoCampus Pompeu Fabra University, Ernest Lluch, 32 (Porta Laietana), 08302 Mataró-Barcelona, Spain; (N.S.-P.); (S.S.-N.); (L.A.-A.); (M.G.-F.); (L.M.A.); (A.P.F.); (A.G.-F.); (J.C.-O.); (X.V.); (M.G.B.)
| | - Lluís Albesa-Albiol
- School of Health Sciences, TecnoCampus Pompeu Fabra University, Ernest Lluch, 32 (Porta Laietana), 08302 Mataró-Barcelona, Spain; (N.S.-P.); (S.S.-N.); (L.A.-A.); (M.G.-F.); (L.M.A.); (A.P.F.); (A.G.-F.); (J.C.-O.); (X.V.); (M.G.B.)
| | - Montserrat Girabent-Farrés
- School of Health Sciences, TecnoCampus Pompeu Fabra University, Ernest Lluch, 32 (Porta Laietana), 08302 Mataró-Barcelona, Spain; (N.S.-P.); (S.S.-N.); (L.A.-A.); (M.G.-F.); (L.M.A.); (A.P.F.); (A.G.-F.); (J.C.-O.); (X.V.); (M.G.B.)
| | - Luciana Moizé Arcone
- School of Health Sciences, TecnoCampus Pompeu Fabra University, Ernest Lluch, 32 (Porta Laietana), 08302 Mataró-Barcelona, Spain; (N.S.-P.); (S.S.-N.); (L.A.-A.); (M.G.-F.); (L.M.A.); (A.P.F.); (A.G.-F.); (J.C.-O.); (X.V.); (M.G.B.)
| | - Alba Pardo Fernández
- School of Health Sciences, TecnoCampus Pompeu Fabra University, Ernest Lluch, 32 (Porta Laietana), 08302 Mataró-Barcelona, Spain; (N.S.-P.); (S.S.-N.); (L.A.-A.); (M.G.-F.); (L.M.A.); (A.P.F.); (A.G.-F.); (J.C.-O.); (X.V.); (M.G.B.)
| | - Adrián García-Fresneda
- School of Health Sciences, TecnoCampus Pompeu Fabra University, Ernest Lluch, 32 (Porta Laietana), 08302 Mataró-Barcelona, Spain; (N.S.-P.); (S.S.-N.); (L.A.-A.); (M.G.-F.); (L.M.A.); (A.P.F.); (A.G.-F.); (J.C.-O.); (X.V.); (M.G.B.)
| | - Jorge Castizo-Olier
- School of Health Sciences, TecnoCampus Pompeu Fabra University, Ernest Lluch, 32 (Porta Laietana), 08302 Mataró-Barcelona, Spain; (N.S.-P.); (S.S.-N.); (L.A.-A.); (M.G.-F.); (L.M.A.); (A.P.F.); (A.G.-F.); (J.C.-O.); (X.V.); (M.G.B.)
| | - Xavier Viñals
- School of Health Sciences, TecnoCampus Pompeu Fabra University, Ernest Lluch, 32 (Porta Laietana), 08302 Mataró-Barcelona, Spain; (N.S.-P.); (S.S.-N.); (L.A.-A.); (M.G.-F.); (L.M.A.); (A.P.F.); (A.G.-F.); (J.C.-O.); (X.V.); (M.G.B.)
| | - Lorena Molina-Raya
- Campus Docent Sant Joan de Déu, Fundación Privada, 08304 Barcelona, Spain;
| | - Manuel Gomis Bataller
- School of Health Sciences, TecnoCampus Pompeu Fabra University, Ernest Lluch, 32 (Porta Laietana), 08302 Mataró-Barcelona, Spain; (N.S.-P.); (S.S.-N.); (L.A.-A.); (M.G.-F.); (L.M.A.); (A.P.F.); (A.G.-F.); (J.C.-O.); (X.V.); (M.G.B.)
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6
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Huang D, Guo J, Yang W, Liu J. Exercise Capacity and Ventilatory Efficiency in Patients With Pulmonary Embolism After Short Duration of Anticoagulation Therapy. Am J Med Sci 2020; 359:140-146. [DOI: 10.1016/j.amjms.2019.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 12/17/2019] [Accepted: 12/21/2019] [Indexed: 10/25/2022]
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Russell S, Beghetti M, Oudiz R, Balagtas C, Zhang M, Ivy D. Effects of oral sildenafil on exercise capacity in children with pulmonary arterial hypertension: a randomised trial. Open Heart 2020; 6:e001149. [PMID: 31908813 PMCID: PMC6927510 DOI: 10.1136/openhrt-2019-001149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 11/03/2022] Open
Abstract
Objective The 16-week, randomised, double-blind Sildenafil in Treatment-Naïve Children, Aged1-17 years, with Pulmonary Arterial Hypertension (STARTS-1) study assessed the effect of sildenafil on cardiopulmonary exercise testing (CPET) in treatment-naïve paediatric patients with pulmonary arterial hypertension (PAH) and included a long-term extension (STARTS-2). CPET has rarely been performed in paediatric patients and we assessed both aerobic capacity with peak oxygen consumption (PVO2) and ventilatory inefficiency with the slope of ventilation to carbon dioxide production (VE/VCO2 slope). Methods Patients (aged 1-17 year) were randomised to low (10 mg), medium (10-40 mg) and high (20-80 mg) sildenafil dose groups. Patients previously treated with placebo in STARTS-1 were randomised to one of three blinded sildenafil dose groups for STARTS-2. CPET was assessed by cycle ergometry at baseline, week 16, and year 1. Results Of the 234 children randomised, 115 could exercise. At week 16, the combined sildenafil dose group had a 7.7% increase in mean PVO2 percent change from baseline compared with placebo (95% CI -0.2% to 15.6%; p=0.056); at year 1, a significant increase in mean percent change in PVO2 from baseline was only observed in the low-dose group (mean of 12.4% and 95% CI 3% to 21.8%). For VE/VCO2 slope, at week 16, the combined dose group had a -9.7% mean change from baseline compared with placebo (95% CI -14.9% to -4.5%; p<0.001); at year 1, there were no significant changes for any dose group. Conclusions Sildenafil monotherapy (combined sildenafil dose group) appeared to improve short-term VE/VCO2 slope versus placebo but did not significantly improve PVO2 in treatment-naïve paediatric patients with PAH who were developmentally able to exercise. Trial registration number NCT00159913 for A1481131, NCT00159874 for A1481156.
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Affiliation(s)
- Stuart Russell
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Childrens University Hospital, Geneva, Switzerland
| | - Ronald Oudiz
- Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
| | | | - Min Zhang
- Pfizer Global Pharmaceuticals, La Jolla, California, USA
| | - Dunbar Ivy
- Division of Pediatric Cardiology, Department of Pediatrics and Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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Vallerand JR, Weatherald J, Laveneziana P. Pulmonary Hypertension and Exercise. Clin Chest Med 2019; 40:459-469. [DOI: 10.1016/j.ccm.2019.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Balmain BN, Seale H, Harris J, Hall K, Lin AC, Sabapathy S, Morris NR. Relating exercise-induced desaturation and gas-exchange in pulmonary artery hypertension. Respir Physiol Neurobiol 2019; 259:58-62. [DOI: 10.1016/j.resp.2018.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 11/30/2022]
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10
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Rafati-Rahimzadeh M, Rafati-Rahimzadeh M, Kazemi S, Moghadamnia AA. Therapeutic options to treat mustard gas poisoning - Review. CASPIAN JOURNAL OF INTERNAL MEDICINE 2019; 10:241-264. [PMID: 31558985 PMCID: PMC6729161 DOI: 10.22088/cjim.10.3.241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/29/2019] [Accepted: 02/03/2019] [Indexed: 11/14/2022]
Abstract
Among the blistering (vesicant) chemical warfare agents (CWA), sulfur mustard is the most important since it is known as the "King of chemical warfare agents". The use of sulfur mustard has caused serious damages in several organs, especially the eyes, skin, respiratory, central and peripheral nervous systems after short and long term exposure, incapacitating and even killing people and troops. In this review, chemical properties, mechanism of actions and their effects on each organ, clinical manifestations, diagnostic evaluation of the actions triage, and treatment of injuries have been described.
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Affiliation(s)
- Mehrdad Rafati-Rahimzadeh
- Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Sohrab Kazemi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Akbar Moghadamnia
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Weatherald J, Sattler C, Garcia G, Laveneziana P. Ventilatory response to exercise in cardiopulmonary disease: the role of chemosensitivity and dead space. Eur Respir J 2018; 51:51/2/1700860. [PMID: 29437936 DOI: 10.1183/13993003.00860-2017] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 11/11/2017] [Indexed: 12/30/2022]
Abstract
The lungs and heart are irrevocably linked in their oxygen (O2) and carbon dioxide (CO2) transport functions. Functional impairment of the lungs often affects heart function and vice versa The steepness with which ventilation (V'E) rises with respect to CO2 production (V'CO2 ) (i.e. the V'E/V'CO2 slope) is a measure of ventilatory efficiency and can be used to identify an abnormal ventilatory response to exercise. The V'E/V'CO2 slope is a prognostic marker in several chronic cardiopulmonary diseases independent of other exercise-related variables such as peak O2 uptake (V'O2 ). The V'E/V'CO2 slope is determined by two factors: 1) the arterial CO2 partial pressure (PaCO2 ) during exercise and 2) the fraction of the tidal volume (VT) that goes to dead space (VD) (i.e. the physiological dead space ratio (VD/VT)). An altered PaCO2 set-point and chemosensitivity are present in many cardiopulmonary diseases, which influence V'E/V'CO2 by affecting PaCO2 Increased ventilation-perfusion heterogeneity, causing inefficient gas exchange, also contributes to the abnormal V'E/V'CO2 observed in cardiopulmonary diseases by increasing VD/VT During cardiopulmonary exercise testing, the PaCO2 during exercise is often not measured and VD/VT is only estimated by taking into account the end-tidal CO2 partial pressure (PETCO2 ); however, PaCO2 is not accurately estimated from PETCO2 in patients with cardiopulmonary disease. Measuring arterial gases (PaO2 and PaCO2 ) before and during exercise provides information on the real (and not "estimated") VD/VT coupled with a true measure of gas exchange efficiency such as the difference between alveolar and arterial O2 partial pressure and the difference between arterial and end-tidal CO2 partial pressure during exercise.
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Affiliation(s)
- Jason Weatherald
- Dept of Medicine, Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada.,Université Paris-Sud and Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Service de Pneumologie, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Caroline Sattler
- Université Paris-Sud and Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Service de Pneumologie, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Gilles Garcia
- Université Paris-Sud and Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Service de Pneumologie, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,These authors contributed equally to this work and are both last authors
| | - Pierantonio Laveneziana
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France .,Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, Dépt "R3S", Pôle PRAGUES, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.,These authors contributed equally to this work and are both last authors
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13
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Tang Y, Yao L, Liu Z, Ma X, Luo Q, Zhao Z, Huang Z, Tu L, Gao L, Jin Q, Ni X, Xiong C. Effect of calcium channel blockers evaluated by cardiopulmonary exercise testing in idiopathic pulmonary arterial hypertension responding to acute pulmonary vasoreactivity testing. Pulm Pharmacol Ther 2017; 43:26-31. [PMID: 28159512 DOI: 10.1016/j.pupt.2017.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 01/21/2017] [Accepted: 01/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The baseline exercise capacity evaluated by cardiopulmonary exercise testing (CPET) and the change after administration of calcium channel blockers (CCB) therapy in patients with vasodilator-responsive idiopathic pulmonary arterial hypertension (VR-IPAH)are unknown. METHODS 25 patients with newly diagnosed VR-IPAH from 1 January 2012 to 16 November 2015 were prospectively enrolled, and 28 age, sex and pulmonary vascular resistance matched newly diagnosed patients with vasodilator-nonresponsive idiopathic pulmonary arterial hypertension (VNR-IPAH) were enrolled. CPET was performed before and after 3.5 ± 0.8 months of CCB or sildenafil therapy. RESULTS Ventilatory efficiency at rest, anaerobic threshold (AT), and peak were significantly higher (lower in V˙E/V˙CO2@AT and higher in PETCO2@AT) in VR-IPAH group than that in VNR-IPAH group. Peak V˙O2 (13.9 ± 2.9 mL kg-1·min-1 vs 16.4 ± 4.1 mL kg-1·min-1, p = 0.001), peak O2 pulse (5.5 ± 0.8 mL min-1·beat-1 vs 6.9 ± 1.3 mL min-1·beat-1, p = 0.001), V˙E/V˙CO2@AT (34.2 ± 5.0 vs 31.6 ± 3.1, p = 0.02) and PETCO2@AT (33.1 ± 4.0 mmHg vs 35.3 ± 3.2 mmHg, p = 0.02) were significantly improved after high dose of CCB therapy, along with improvement of WHO functional class, 6-min walking distance, NT-proBNP and tricuspid regurgitation pressure gradient. CONCLUSIONS Ventilatory efficiency in patients with VR-IPAH is better than that in patients with VNR-IPAH. CCB can improve aerobic capacity and ventilatory efficiency during exercise in patients with VR-IPAH. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov:NCT02061787.
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Affiliation(s)
- Yi Tang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Yao
- Department of Cardiology, People's Hospital of Shouguang City, Shandong, China
| | - Zhihong Liu
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Xiuping Ma
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qin Luo
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihui Zhao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiwei Huang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Laura Tu
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Liu Gao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Jin
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinhai Ni
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changming Xiong
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Morris NR, Seale H, Harris J, Hall K, Lin ACW, Kermeen F. Gas exchange responses during 6-min walk test in patients with pulmonary arterial hypertension. Respirology 2016; 22:165-171. [DOI: 10.1111/resp.12868] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Norman R. Morris
- School of Allied Health Sciences, Menzies Health Institute Queensland; Griffith University; Gold Coast Queensland Australia
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Helen Seale
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Julie Harris
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Kathleen Hall
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Aaron C. W. Lin
- School of Allied Health Sciences, Menzies Health Institute Queensland; Griffith University; Gold Coast Queensland Australia
| | - Fiona Kermeen
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
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Pinkstaff SO, Burger CD, Daugherty J, Bond S, Arena R. Cardiopulmonary exercise testing in patients with pulmonary hypertension: clinical recommendations based on a review of the evidence. Expert Rev Respir Med 2016; 10:279-95. [DOI: 10.1586/17476348.2016.1144475] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Puente-Maestu L, Palange P, Casaburi R, Laveneziana P, Maltais F, Neder JA, O'Donnell DE, Onorati P, Porszasz J, Rabinovich R, Rossiter HB, Singh S, Troosters T, Ward S. Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement. Eur Respir J 2016; 47:429-60. [DOI: 10.1183/13993003.00745-2015] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/14/2015] [Indexed: 12/20/2022]
Abstract
This document reviews 1) the measurement properties of commonly used exercise tests in patients with chronic respiratory diseases and 2) published studies on their utilty and/or evaluation obtained from MEDLINE and Cochrane Library searches between 1990 and March 2015.Exercise tests are reliable and consistently responsive to rehabilitative and pharmacological interventions. Thresholds for clinically important changes in performance are available for several tests. In pulmonary arterial hypertension, the 6-min walk test (6MWT), peak oxygen uptake and ventilation/carbon dioxide output indices appear to be the variables most responsive to vasodilators. While bronchodilators do not always show clinically relevant effects in chronic obstructive pulmonary disease, high-intensity constant work-rate (endurance) tests (CWRET) are considerably more responsive than incremental exercise tests and 6MWTs. High-intensity CWRETs need to be standardised to reduce interindividual variability. Additional physiological information and responsiveness can be obtained from isotime measurements, particularly of inspiratory capacity and dyspnoea. Less evidence is available for the endurance shuttle walk test. Although the incremental shuttle walk test and 6MWT are reliable and less expensive than cardiopulmonary exercise testing, two repetitions are needed at baseline. All exercise tests are safe when recommended precautions are followed, with evidence suggesting that no test is safer than others.
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Mehta BB, Auger DA, Gonzalez JA, Workman V, Chen X, Chow K, Stump CJ, Mazimba S, Kennedy JLW, Gay E, Salerno M, Kramer CM, Epstein FH, Bilchick KC. Detection of elevated right ventricular extracellular volume in pulmonary hypertension using Accelerated and Navigator-Gated Look-Locker Imaging for Cardiac T1 Estimation (ANGIE) cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2015; 17:110. [PMID: 26692265 PMCID: PMC4687111 DOI: 10.1186/s12968-015-0209-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 11/19/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Assessment of diffuse right ventricular (RV) fibrosis is of particular interest in pulmonary hypertension (PH) and heart failure (HF). Current cardiovascular magnetic resonance (CMR) T1 mapping techniques such as Modified Look-Locker inversion recovery (MOLLI) imaging have limited resolution, but accelerated and navigator-gated Look-Locker imaging for cardiac T1 estimation (ANGIE) is a novel CMR sequence with spatial resolution suitable for T1 mapping of the RV. We tested the hypothesis that patients with PH would have significantly more RV fibrosis detected with MRI ANGIE compared with normal volunteers and patients having HF with reduced (LV) ejection fraction (HFrEF) without co-existing PH, independent of RV dilitation and dysfunction. METHODS Patients with World Health Organization group 1 or group 4 PH, patients with HFrEF without PH, and normal volunteers were recruited to undergo contrast-enhanced CMR. RV and LV extracellular volume fractions (RV-ECV and LV-ECV) were determined using pre-contrast and post-contrast T1 mapping using ANGIE (RV and LV) and MOLLI (LV only). RESULTS Thirty-two participants (53.1% female, median age 52 years, IQR 26-65 years) were enrolled, including n = 12 with PH, n = 10 having HFrEF without co-existing PH, and n = 10 normal volunteers. ANGIE ECV imaging was of high quality, and ANGIE measurements of LV-ECV were highly correlated with those of MOLLI (r = 0.91; p < 0.001). The RV-ECV in PH patients was 27.2% greater than the RV-ECV in normal volunteers (0.341 v. 0.268; p < 0.0001) and 18.9% greater than the RV-ECV in HFrEF patients without PH (0.341 v. 0.287; p < 0.0001). RV-ECV was greater than LV-ECV in PH (RV-LV difference = 0.04), but RV-ECV was nearly equivalent to LV-ECV in normal volunteers (RV-LV difference = 0.002) (p < 0.0001 for RV-LV difference in PH versus normal volunteers). RV-ECV was linearly associated with both increasing RVEDVI (p = 0.049) and decreasing RVEF (p = 0.04) in a multivariable linear model, but PH was still associated with greater RV-ECV even after adjustment for RVEDVI and RVEF. CONCLUSIONS Pre- and post-contrast ANGIE imaging provides high-resolution ECV determination for the RV. PH is independently associated with increased RV-ECV even after adjustment for RV dilatation and dysfunction, consistent with an independent effect of PH on fibrosis. ANGIE RV imaging merits further clinical evaluation in PH.
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Affiliation(s)
- Bhairav B Mehta
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA.
| | - Daniel A Auger
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA.
| | - Jorge A Gonzalez
- Department of Medicine, University of Virginia Health System, P.O. Box 800158, Charlottesville, VA, 22908, USA.
| | - Virginia Workman
- Department of Medicine, University of Virginia Health System, P.O. Box 800158, Charlottesville, VA, 22908, USA.
| | - Xiao Chen
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA.
| | - Kelvin Chow
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA.
| | - Claire J Stump
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA.
| | - Sula Mazimba
- Department of Medicine, University of Virginia Health System, P.O. Box 800158, Charlottesville, VA, 22908, USA.
| | - Jamie L W Kennedy
- Department of Medicine, University of Virginia Health System, P.O. Box 800158, Charlottesville, VA, 22908, USA.
| | - Elizabeth Gay
- Department of Medicine, University of Virginia Health System, P.O. Box 800158, Charlottesville, VA, 22908, USA.
| | - Michael Salerno
- Department of Medicine, University of Virginia Health System, P.O. Box 800158, Charlottesville, VA, 22908, USA.
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA.
- Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | - Christopher M Kramer
- Department of Medicine, University of Virginia Health System, P.O. Box 800158, Charlottesville, VA, 22908, USA.
- Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA.
- Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | - Kenneth C Bilchick
- Department of Medicine, University of Virginia Health System, P.O. Box 800158, Charlottesville, VA, 22908, USA.
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Low AT, Medford ARL, Millar AB, Tulloh RMR. Lung function in pulmonary hypertension. Respir Med 2015; 109:1244-9. [PMID: 26033642 DOI: 10.1016/j.rmed.2015.05.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/18/2015] [Accepted: 05/24/2015] [Indexed: 02/06/2023]
Abstract
Breathlessness is a common symptom in pulmonary hypertension (PH) and an important cause of morbidity. Though this has been attributed to the well described pulmonary vascular abnormalities and subsequent cardiac remodelling, changes in the airways of these patients have also been reported and may contribute to symptoms. Our understanding of these airway abnormalities is poor with conflicting findings in many studies. The present review evaluates these studies for the major PH groups. In addition we describe the role of cardiopulmonary exercise testing in the assessment of pulmonary arterial hypertension (PAH) by evaluating cardiopulmonary interaction during exercise. As yet, the reasons for the abnormalities in lung function are unclear, but potential causes and the possible role of inflammation are discussed. Future research is required to provide a better understanding of this to help improve the management of these patients.
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Affiliation(s)
- A T Low
- University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, United Kingdom.
| | - A R L Medford
- North Bristol Lung Centre, Southmead Hospital, Southmead Road, Bristol, United Kingdom.
| | - A B Millar
- Academic Respiratory Unit, Southmead Hospital, Southmead Road, Bristol, United Kingdom.
| | - R M R Tulloh
- University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, United Kingdom.
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19
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Exercise Physiology and Pulmonary Hemodynamic Abnormality in PH Patients with Exercise Induced Venous-To-Systemic Shunt. PLoS One 2015; 10:e0121690. [PMID: 25918847 PMCID: PMC4412481 DOI: 10.1371/journal.pone.0121690] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 02/16/2015] [Indexed: 12/27/2022] Open
Abstract
Objectives To identify the pulmonary hypertension (PH) patients who develop an exercise induced venous-to-systemic shunt (EIS) by performing the cardiopulmonary exercise test (CPET), analyse the changes of CPET measurements during exercise and compare the exercise physiology and resting pulmonary hemodynamics between shunt-PH and no-shunt-PH patients. Methods Retrospectively, resting pulmonary function test (PFT), right heart catheterization (RHC), and CPET for clinical evaluation of 104 PH patients were studied. Results Considering all 104 PH patients by three investigators, 37 were early EIS+, 61 were EIS-, 3 were late EIS+, and 3 others were placed in the discordant group. PeakVO2, AT and OUES were all reduced in the shunt-PH patients compared with the no-shunt-PH subjects, whereas VE/VCO2 slope and the lowest VE/VCO2 increased. Besides, the changes and the response characteristics of the key CPET parameters at the beginning of exercise in the shunt group were notably different from those of the no shunt one. At cardiac catheterization, the shunt patients had significantly increased mean pulmonary artery pressure (mPAP), mean right atrial pressure (mRAP) and pulmonary vascular resistance (PVR), reduced cardiac output (CO) and cardiac index (CI) compared with the no shunt ones (P<0.05). Resting CO was significantly correlated with exercise parameters of AT (r = 0.527, P<0.001), OUES (r = 0.410, P<0.001) and Peak VO2 (r = 0.405, P<0.001). PVR was significantly, but weakly, correlated with the above mentioned CPET parameters. In Conclusions CPET may allow a non-invasive method for detecting an EIS and assessing the severity of the disease in PH patients.
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20
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Paliwal S, Mittal A, Sharma M, pandey A, Singh A, Paliwal S. Pharmacophore and molecular docking based identification of novel structurally diverse PDE-5 inhibitors. Med Chem Res 2014. [DOI: 10.1007/s00044-014-1144-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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21
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Tan X, Yang W, Guo J, Zhang Y, Wu C, Sapkota R, Kushwaha SP, Gong S, Sun X, Liu J. Usefulness of decrease in oxygen uptake efficiency to identify gas exchange abnormality in patients with idiopathic pulmonary arterial hypertension. PLoS One 2014; 9:e98889. [PMID: 24905576 PMCID: PMC4048265 DOI: 10.1371/journal.pone.0098889] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/08/2014] [Indexed: 12/21/2022] Open
Abstract
Background Decline in oxygen uptake efficiency (OUE), especially during exercise, is found in patients with chronic heart failure. In this study we aimed to test the validity and usefulness of OUE in evaluating gas exchange abnormality of patients with idiopathic pulmonary arterial hypertension (IPAH). Methods We retrospectively investigated the cardiopulmonary exercise test (CPET) with gas exchange measurements in 32 patients with confirmed IPAH. All patients also had resting hemodynamic measurements and pulmonary function test (PFT). Sixteen healthy subjects, matched by age, sex, and body size were used as controls, also had CPET and PFT measurements. Results In IPAH patients, the magnitude of absolute and percentage of predicted (%pred) oxygen uptake efficiency slope (OUES) and oxygen uptake efficiency plateau (OUEP), as well as several other CPET parameters, were strikingly worse than healthy subjects (P<0.0001). Pattern of changes in OUE in patients is similar to that in controls, In IPAH patients, OUE values at rest, warming up, anaerobic threshold and peak exercise were all significantly lower than in normal (P<0.0001). OUEP%pred, better than OUES%pred, correlated significantly with New York Heart Association (NYHA) functional Class (r = −0.724, P<0.005), Total Pulmonary Vascular Resistance (TPVR) (r = −0.694, P<0.005), diffusing capacity for carbon monoxide (DLCO) (r = 0.577, P<0.05), and the lowest ventilation versus CO2 output ratio during exercise (LowestV˙E/V˙CO2) (r = −0.902, P<0.0001). In addition, the coefficient of variation (COV) of OUEP was lower (20.9%) markedly than OUES (34.3%) (P<0.0001). Conclusions In patients with IPAH, OUES and OUEP are both significantly lower than the healthy subjects. OUEP is a better physiological parameter than OUES in evaluating the gas exchange abnormality of patients with IPAH.
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Affiliation(s)
- Xiaoyue Tan
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
- State Key Laboratory of Cardiovascular Disease, Heart-Lung Function Testing Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenlan Yang
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
| | - Jian Guo
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
| | - Yan Zhang
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
- Respiratory Division, Hangzhou, Zhejiang Provincial Hospital of traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Changwei Wu
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
| | - Rikesh Sapkota
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
| | - Shailendra Prasad Kushwaha
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
| | - Sugang Gong
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
| | - Xingguo Sun
- State Key Laboratory of Cardiovascular Disease, Heart-Lung Function Testing Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail: (XGS); (JML)
| | - Jinming Liu
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
- * E-mail: (XGS); (JML)
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22
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The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension. Diseases 2014. [DOI: 10.3390/diseases2020120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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23
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Szwejkowski BR, Elder DH, Shearer F, Jack D, Choy AMJ, Pringle SD, Struthers AD, George J, Lang CC. Pulmonary hypertension predicts all-cause mortality in patients with heart failure: a retrospective cohort study. Eur J Heart Fail 2014; 14:162-7. [DOI: 10.1093/eurjhf/hfr159] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Benjamin R. Szwejkowski
- Centre for Cardiovascular and Lung Biology; University of Dundee, Ninewells Hospital and Medical School; Dundee DD1 9SY UK
| | | | | | - David Jack
- Medical School; University of Dundee; Dundee UK
| | - Anna Maria J. Choy
- Centre for Cardiovascular and Lung Biology; University of Dundee, Ninewells Hospital and Medical School; Dundee DD1 9SY UK
| | | | - Allan D. Struthers
- Centre for Cardiovascular and Lung Biology; University of Dundee, Ninewells Hospital and Medical School; Dundee DD1 9SY UK
| | - Jacob George
- Centre for Cardiovascular and Lung Biology; University of Dundee, Ninewells Hospital and Medical School; Dundee DD1 9SY UK
| | - Chim C. Lang
- Centre for Cardiovascular and Lung Biology; University of Dundee, Ninewells Hospital and Medical School; Dundee DD1 9SY UK
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Groepenhoff H, Vonk-Noordegraaf A, van de Veerdonk MC, Boonstra A, Westerhof N, Bogaard HJ. Prognostic relevance of changes in exercise test variables in pulmonary arterial hypertension. PLoS One 2013; 8:e72013. [PMID: 24039732 PMCID: PMC3764059 DOI: 10.1371/journal.pone.0072013] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/04/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Exercise variables determined in patients with pulmonary arterial hypertension (PAH) at the time of diagnosis, predict survival. It is unknown whether upon treatment, subsequent changes in these exercise variables reflect improvements in survival. The aim of this study was to determine changes in exercise variables in PAH patients and to relate these changes to survival. METHODS Baseline cardiopulmonary exercise test (CPET) variables and six-minute-walk-distance (6MWD) were available from 65 idiopathic PAH patients (50 females; mean age 45±2yrs). The same variables were determined after treatment (13months) in a sub group of 43 patients. To estimate the association between changes in exercise variables and changes in cardiac function, right-ventricle ejection fraction (RVEF) was measured by cardiac MRI at baseline and after treatment in 34 patients. Mean follow-up time after the second CPET was 53 (range: 4-111) months. Kaplan-Meier analysis was used to relate survival to baseline and treatment-associated changes in exercise variables. RESULTS Survivors showed a significantly greater change in maximal oxygen uptake than non-survivors and this change in aerobic capacity was significantly related to changes in RVEF. From baseline until the end of the study period, two patients underwent a lung transplantation and 19 patients died. Survival analysis showed that baseline 6MWD (p<0.0001), maximal heart rate (p<0.0001) and the slope relating ventilation with carbon dioxide production (p≤0.05) were significant predictors of survival, whereas baseline oxygen uptake and oxygen pulse held no predictive value. Treatment associated changes in 6MWD (p<0.01), maximal heart rate (p<0.05), oxygen uptake (p<0.001) and oxygen pulse predicted survival (p<0.05), whereas changes in the slope relating ventilation with carbon dioxide production did not. CONCLUSION Exercise variables with prognostic significance when determined at baseline, retain their prognostic relevance after treatment. However, when changes in exercise variables upon treatment are considered, a different set of variables provides prognostic information.
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Affiliation(s)
- Herman Groepenhoff
- Department of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Anton Vonk-Noordegraaf
- Department of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Mariëlle C. van de Veerdonk
- Department of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Anco Boonstra
- Department of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Nico Westerhof
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Harm J. Bogaard
- Department of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
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25
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Ferreira EVM, Ota-Arakaki JS, Ramos RP, Barbosa PB, Almeida M, Treptow EC, Valois FM, Nery LE, Neder JA. Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension. Eur J Prev Cardiol 2013; 21:1409-19. [PMID: 23787797 DOI: 10.1177/2047487313494293] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increased ventilatory (.VE) response to carbon dioxide output (.VCO2) is a key finding of incremental cardiopulmonary exercise testing in both heart failure and pulmonary arterial hypertension (PAH). As with heart failure, measures of excessive exercise ventilation considering high-to-peak exercise .VE-VCO2 might have higher prognostic relevance than those restrained to sub-maximal exercise in PAH. DESIGN Cross-sectional and observational study on a tertiary center. METHODS Eighty-four patients (36 idiopathic and 48 with associated conditions) were followed up for up to five years. Excessive exercise ventilation was calculated as a slope (Δ .VE/Δ .VCO2 to the respiratory compensation point (RCP) and to exercise cessation (PEAK)) and as a ratio (.VE-VCO2 at the anaerobic threshold (AT) and at PEAK). RESULTS Thirteen patients died and three had atrial septostomy. Multivariable regression analyses revealed that Δ .VE/Δ .VCO2(PEAK) <55 and .VE/.VCO2(PEAK) <57 were better related to prognosis than Δ .VE/Δ .VCO2(RCP) and .VE/.VCO2(AT) (p < 0.01). Δ oxygen uptake (.VO2)/Δ work rate >5.5 ml/min per W was the only other independent prognostic index. According to a Kaplan-Meier survival analysis, 96.9% (90.8% to 100%) of patients showing Δ .VE/Δ .VCO2(PEAK) <55 and Δ .VO2/Δ work rate >5.5 ml/min per W were free from a PAH-related event. In contrast, 74.7% (70.1% to 78.2%) with both parameters outside these ranges had a negative outcome. CONCLUSION Measurements of excessive exercise ventilation which consider all data points maximize the usefulness of incremental cardiopulmonary exercise testing in the prognosis evaluation of PAH.
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Affiliation(s)
- Eloara V M Ferreira
- Pulmonary Vascular Group, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil
| | - Jaquelina S Ota-Arakaki
- Pulmonary Vascular Group, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil
| | - Roberta P Ramos
- Pulmonary Vascular Group, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil
| | - Priscila B Barbosa
- Pulmonary Vascular Group, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil
| | - Melline Almeida
- Pulmonary Vascular Group, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil
| | - Erika C Treptow
- Pulmonary Vascular Group, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil
| | - Fabricio M Valois
- Pulmonary Vascular Group, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil
| | - Luiz E Nery
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil
| | - J Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil Division of Respiratory and Critical Care Medicine, Department of Medicine, Queeńs University, Kingston, Canada
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26
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Ramos RP, Alencar MCN, Treptow E, Arbex F, Ferreira EMV, Neder JA. Clinical usefulness of response profiles to rapidly incremental cardiopulmonary exercise testing. Pulm Med 2013; 2013:359021. [PMID: 23766901 PMCID: PMC3666297 DOI: 10.1155/2013/359021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 12/17/2012] [Accepted: 01/15/2013] [Indexed: 02/06/2023] Open
Abstract
The advent of microprocessed "metabolic carts" and rapidly incremental protocols greatly expanded the clinical applications of cardiopulmonary exercise testing (CPET). The response normalcy to CPET is more commonly appreciated at discrete time points, for example, at the estimated lactate threshold and at peak exercise. Analysis of the response profiles of cardiopulmonary responses at submaximal exercise and recovery, however, might show abnormal physiologic functioning which would not be otherwise unraveled. Although this approach has long been advocated as a key element of the investigational strategy, it remains largely neglected in practice. The purpose of this paper, therefore, is to highlight the usefulness of selected submaximal metabolic, ventilatory, and cardiovascular variables in different clinical scenarios and patient populations. Special care is taken to physiologically justify their use to answer pertinent clinical questions and to the technical aspects that should be observed to improve responses' reproducibility and reliability. The most recent evidence in favor of (and against) these variables for diagnosis, impairment evaluation, and prognosis in systemic diseases is also critically discussed.
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Affiliation(s)
- Roberta P. Ramos
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Maria Clara N. Alencar
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Erika Treptow
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Flávio Arbex
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Eloara M. V. Ferreira
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - J. Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University and Kingston General Hospital, Richardson House, 102 Stuart Street, Kingston, ON, Canada K7L 2V6
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Razavi SM, Salamati P, Harandi AA, Ghanei M. Prevention and treatment of respiratory consequences induced by sulfur mustard in Iranian casualties. Int J Prev Med 2013; 4:383-9. [PMID: 23671768 PMCID: PMC3650588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/13/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND About 100,000 Iranian have been exposed to chemical weapons during Iraq-Iran conflict (1980-88). After being spent of more than two decades, still about 30,000 of them are under follow-up treatment. The main aim of this study was to review various preventive and therapeutic methods for injured patients with sulfur mustard in different phases. METHODS For gathering information, we have used the electronic databases including Scopus, Medline, ISI, IranMedex, Irandoc sites. According to this search strategy, 104 published articles associated to respiratory problems and among them 50 articles related to prevention and treatment of respiratory problems were found and reviewed. RESULTS There is not any curative treatment for sulfur mustard induced lung injuries, but some valuable experienced measures for prevention and palliative treatments are available. Some useful measures in acute phase include: Symptomatic management, oxygen supplementation, tracheostomy in laryngospasm, use of moist air, respiratory physical therapy, mucolytic agents and bronchodilators. In the chronic phases, these measures include: Periodic clinical examinations, administration of inhaled corticosteroids alone or with long-acting beta 2 agonists, use of antioxidants, magnesium ions, long term oxygen supplement, therapeutic bronchoscopy, laser therapy, and use of respiratory tract stents. CONCLUSIONS Most treatments are symptomatic but using preventive points immediately after exposure could improve following outcomes.
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Affiliation(s)
- Seyed M. Razavi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Payman Salamati
- Department of Community Medicine, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran,Correspondence to: Associate Prof. Payman Salamati, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Sina Hospital, Hassan Abad Square, Imam Khomeini Avenue, Tehran, Iran. E-mail:
| | - Ali Amini Harandi
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Ghanei
- Research Center of Chemical Injuries, Baqiyatllah Medical Sciences University, Tehran, Iran
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Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, Arena R, Fletcher GF, Forman DE, Kitzman DW, Lavie CJ, Myers J. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation 2012; 126:2261-74. [PMID: 22952317 PMCID: PMC4777325 DOI: 10.1161/cir.0b013e31826fb946] [Citation(s) in RCA: 538] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, Arena R, Fletcher GF, Forman DE, Kitzman DW, Lavie CJ, Myers J. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J 2012; 33:2917-27. [DOI: 10.1093/eurheartj/ehs221] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Marco Guazzi
- Department of Medical Sciences, Cardiology, I.R.C.C.S. San Donato Hospital, University of Milan, San Donato Milanese, P.za Malan, 2, 20097, Milan, Italy
| | - Volker Adams
- Department of Cardiology, University Leipzig–Heart Center Leipzig, Leipzig, Germany
| | - Viviane Conraads
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Martin Halle
- Department of Prevention and Sports Medicine, Technische Universität München, Munich, Germany
| | - Alessandro Mezzani
- Exercise Pathophysiology Laboratory, Cardiac Rehabilitation Division, S. Maugeri Foundation IRCCS, Scientific Institute of Veruno, Veruno (NO), Italy
| | - Luc Vanhees
- Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, KU Leuven (University of Leuven), Leuven, Belgium
| | - Ross Arena
- Department of Orthopaedics and Rehabilitation – Division of Physical Therapy and Department of Internal Medicine – Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | | | - Daniel E. Forman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Dalane W. Kitzman
- Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carl J. Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto Health Care System, Stanford University, Palo Alto, CA, USA
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Paolillo S, Farina S, Bussotti M, Iorio A, Filardi PP, Piepoli MF, Agostoni P. Exercise testing in the clinical management of patients affected by pulmonary arterial hypertension. Eur J Prev Cardiol 2011; 19:960-71. [DOI: 10.1177/1741826711426635] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stefania Paolillo
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Maurizio Bussotti
- Cardiologia Riabilitativa, Fondazione S Maugeri, IRCCS, Milan, Italy
| | - Annamaria Iorio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Ospedali Riuniti di Trieste, Università degli Studi di Trieste, Trieste, Italy
| | - Pasquale Perrone Filardi
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiology Department, G da Saliceto Hospital, Piacenza, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Cardiovascular Sciences, University of Milan, Milan, Italy
- Division of Respiratory Medicine and Critical Care, University of Washington, Seattle, WA, USA
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Arena R, Guazzi M, Myers J, Grinnen D, Forman DE, Lavie CJ. Cardiopulmonary exercise testing in the assessment of pulmonary hypertension. Expert Rev Respir Med 2011; 5:281-93. [PMID: 21510737 DOI: 10.1586/ers.11.4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The assessment of patients with suspected or confirmed pulmonary arterial hypertension (PAH) and secondary pulmonary hypertension (PH) continues to evolve and, in recent years, evidence demonstrating that cardiopulmonary exercise testing (CPX) provides valuable information has grown at an impressive rate. The key premise supporting the use of CPX is that certain variables obtained provide insight into the degree of ventilation/perfusion mismatching secondary to altered pulmonary hemodynamics. In this article, we discuss the pathophysiology of PAH and secondary PH and its impact on cardiac function, review the clinical presentation of patients with elevated pulmonary pressures and outline a case for the use of CPX as an integral assessment technique, discuss CPX technology and testing procedures, and review the current state of available evidence and provide clinical recommendations for CPX in the setting of known or suspected PAH and secondary PH.
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Affiliation(s)
- Ross Arena
- Virginia Commonwealth University, Richmond, VA, USA.
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Arena R, Sietsema KE. Cardiopulmonary exercise testing in the clinical evaluation of patients with heart and lung disease. Circulation 2011; 123:668-80. [PMID: 21321183 DOI: 10.1161/circulationaha.109.914788] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ross Arena
- Department of Physical Therapy, Virginia Commonwealth University, Richmond Virginia 23298-0224, USA.
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Yang-Ting S, Aboulhosn J, Sun XG, Child JS, Sietsema KE. Effects of Pulmonary Vasodilator Therapy on Ventilatory Efficiency during Exercise in Adults with Eisenmenger Syndrome. CONGENIT HEART DIS 2011; 6:139-46. [DOI: 10.1111/j.1747-0803.2011.00490.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Methvin AB, Owens AT, Emmi AG, Allen M, Wiegers SE, Dries DL, Margulies KB, Forfia PR. Ventilatory Inefficiency Reflects Right Ventricular Dysfunction in Systolic Heart Failure. Chest 2011; 139:617-625. [DOI: 10.1378/chest.10-0318] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Woods PR, Frantz RP, Johnson BD. The usefulness of submaximal exercise gas exchange in pulmonary arterial hypertension: a case series. Clin Med Insights Circ Respir Pulm Med 2010; 4:35-40. [PMID: 21037968 PMCID: PMC2964670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Submaximal exercise gas exchange may be a useful tool to track responses to therapy in pulmonary arterial hypertension (PAH) patients. METHODS Three patients diagnosed with idiopathic PAH, on differing therapies, were included. Standard clinical tests (echocardiography; 6 minute walk) were performed pre and 3-5 months after treatment. Gas exchange was measured during 3 minutes of step exercise at both time points. RESULTS Gas exchange variables, end tidal CO(2) (P(ET)CO(2)) and the ratio of ventilation to CO(2) production (V(E)/VCO(2)), during submaximal exercise were able to track patient responses to therapy over a 3-5 month period. Two patients demonstrated positive improvements, with an increased P(ET)CO(2) and decreased V(E)/VCO(2) during light exercise, in response to an altered therapeutic regime. The third patient had a worsening of gas exchange (decreased P(ET)CO(2) and increased V(E)/VCO(2)) following no changes in the medical regime from the baseline visit. CONCLUSION Gas exchange variables measured during light submaximal exercise, such as P(ET)CO(2) and V(E)/VCO(2), may be able to better detect small changes in functional status following treatment and could, therefore, be a useful tool to track disease severity in PAH patients. Further study is required to determine the clinical usefulness of these gas exchange variables.
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Buckley MS, Staib RL, Wicks LM, Feldman JP. Phosphodiesterase-5 inhibitors in management of pulmonary hypertension: safety, tolerability, and efficacy. Drug Healthc Patient Saf 2010; 2:151-61. [PMID: 21701627 PMCID: PMC3108715 DOI: 10.2147/dhps.s6215] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Indexed: 11/23/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease that causes severe disability and has no cure. Over the past 20 years, a variety of treatment options have evolved for the management of PAH. With an expanded therapeutic armamentarium come more complex decisions regarding treatment options. Agent selection depends upon several factors including efficacy, side effect profile, and cost, as well as convenience of administration. We have undertaken a review of phosphodiesterase-5 (PDE-5) inhibitors in PAH with a focus on efficacy and safety. A literature search was conducted using the Medline and Cochrane Central Register of Controlled Trials databases (1966-February 2010) for relevant randomized clinical studies. Overall, 10 studies met our inclusion criteria. Sildenafil was the most commonly studied agent, followed by tadalafil and vardenafil. Most trials found that the PDE-5 inhibitors significantly improved exercise capacity and lowered pulmonary pressures. However, there were conflicting results regarding these agents' impact on improving cardiac function and functional class. Overall, these medications were effective and well tolerated with a relatively benign side effect profile. The PDE-5 inhibitors are an important option in treating PAH. While most of the published clinical data involved sildenafil, the other PDE-5 inhibitors show promise as well. Further studies are needed to determine the optimal doses of this therapeutic drug class, as well as its effects as adjunctive therapy with other agents in PAH.
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Affiliation(s)
| | - Robin L Staib
- Department of Pharmacy, Banner Good Samaritan Medical Center, and
| | - Laura M Wicks
- Department of Pharmacy, Banner Good Samaritan Medical Center, and
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Usefulness of right-to-left shunting and poor exercise gas exchange for predicting prognosis in patients with pulmonary arterial hypertension. Am J Cardiol 2010; 105:1186-91. [PMID: 20381675 DOI: 10.1016/j.amjcard.2009.12.024] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 12/03/2009] [Accepted: 12/03/2009] [Indexed: 11/22/2022]
Abstract
We hypothesized that the longitudinal changes in peak oxygen uptake, ventilatory efficiency, and exercise-induced right-to-left shunting in patients with pulmonary arterial hypertension (PAH) would predict outcomes better than baseline measurements alone. Patients with PAH die prematurely. Identifying prognostic markers is critical for treating patients with PAH; however, longitudinal prognostic information of PAH is limited. We enrolled 103 patients with PAH into a long-term, prospective outcome study using serial cardiopulmonary exercise testing to measure the peak oxygen uptake, ventilatory efficiency (ratio of ventilation to carbon dioxide output at the anaerobic threshold), right-to-left shunting, and other factors in patients treated with optimal therapy. The patients were followed up for a mean of 4.7 years. During the study period, 20 patients died, and 3 underwent lung transplantation. The baseline peak oxygen uptake and ventilatory efficiency was 0.79 L/min and 49 (normal <34), respectively, reflecting severe disease. Poorer ventilatory efficiency and greater New York Heart Association classification were associated with poor outcome at baseline and at follow-up. On multivariate analysis, the persistence or development of an exercise-induced right-to-left shunt strongly predicted death or transplantation (p <0.0001), independent of the hemodynamics and all other exercise measures, including peak oxygen uptake and ventilatory efficiency. The absence of a shunt at baseline was associated with a 20% rate of nonsurvival, which decreased to 7% at follow-up. A poorer ventilatory efficiency appeared to be associated with a poor outcome in patients without a shunt. In conclusion, a persistent exercise-induced right-to-left shunt and poor ventilatory efficiency were highly predictive of poor outcomes in patients with pulmonary arterial hypertension.
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Arena R, Lavie CJ, Milani RV, Myers J, Guazzi M. Cardiopulmonary exercise testing in patients with pulmonary arterial hypertension: An evidence-based review. J Heart Lung Transplant 2010; 29:159-73. [DOI: 10.1016/j.healun.2009.09.003] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 09/08/2009] [Accepted: 09/08/2009] [Indexed: 11/17/2022] Open
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Woods PR, Frantz RP, Johnson BD. The Usefulness of Submaximal Exercise Gas Exchange in Pulmonary Arterial Hypertension: A Case Series. CLINICAL MEDICINE INSIGHTS: CIRCULATORY, RESPIRATORY AND PULMONARY MEDICINE 2010. [DOI: 10.1177/117954842020100402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Submaximal exercise gas exchange may be a useful tool to track responses to therapy in pulmonary arterial hypertension (PAH) patients. Methods Three patients diagnosed with idiopathic PAH, on differing therapies, were included. Standard clinical tests (echocardiography; 6 minute walk) were performed pre and 3-5 months after treatment. Gas exchange was measured during 3 minutes of step exercise at both time points. Results Gas exchange variables, end tidal CO2 (PETCO2) and the ratio of ventilation to CO2 production (VE/VCO2), during submaximal exercise were able to track patient responses to therapy over a 3-5 month period. Two patients demonstrated positive improvements, with an increased PETCO2 and decreased VE/VCO2 during light exercise, in response to an altered therapeutic regime. The third patient had a worsening of gas exchange (decreased PETCO2 and increased VE/VCO2) following no changes in the medical regime from the baseline visit. Conclusion Gas exchange variables measured during light submaximal exercise, such as PETCO2 and VE/VCO2, may be able to better detect small changes in functional status following treatment and could, therefore, be a useful tool to track disease severity in PAH patients. Further study is required to determine the clinical usefulness of these gas exchange variables.
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Affiliation(s)
- Paul R. Woods
- Division of Cardiovascular Disease, College of Medicine, Mayo Clinic, Rochester, MN, USA. This work was supported by Gilead and NIH Grant HL71478
| | - Robert P. Frantz
- Division of Cardiovascular Disease, College of Medicine, Mayo Clinic, Rochester, MN, USA. This work was supported by Gilead and NIH Grant HL71478
| | - Bruce D. Johnson
- Division of Cardiovascular Disease, College of Medicine, Mayo Clinic, Rochester, MN, USA. This work was supported by Gilead and NIH Grant HL71478
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McLaughlin VV, Badesch DB, Delcroix M, Fleming TR, Gaine SP, Galiè N, Gibbs JSR, Kim NH, Oudiz RJ, Peacock A, Provencher S, Sitbon O, Tapson VF, Seeger W. End Points and Clinical Trial Design in Pulmonary Arterial Hypertension. J Am Coll Cardiol 2009; 54:S97-S107. [DOI: 10.1016/j.jacc.2009.04.007] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 04/15/2009] [Indexed: 01/23/2023]
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Giardini A, Hager A, Lammers AE, Derrick G, Müller J, Diller GP, Dimopoulos K, Odendaal D, Gargiulo G, Picchio FM, Gatzoulis MA. Ventilatory Efficiency and Aerobic Capacity Predict Event-Free Survival in Adults With Atrial Repair for Complete Transposition of the Great Arteries. J Am Coll Cardiol 2009; 53:1548-55. [DOI: 10.1016/j.jacc.2009.02.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 01/27/2009] [Accepted: 02/03/2009] [Indexed: 11/29/2022]
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Abstract
This review aims to elucidate the possible effects of phosphodiesterase-5 (PDE5) inhibitors on sperm functions. PDEs hydrolyze cyclic nucleotides, and together with adenylyl and guanylyl cyclase, which catalyze the formation of cAMP and cGMP, regulate the levels of these second messengers in cells. cGMP-specific PDE5 is one of the PDEs that have been intensively studied because of its fundamental pharmacological relevance, as oral PDE5 inhibitors are used successfully in treating erectile dysfunction. In addition, they have shown diverse beneficial actions in different disease categories. Specific relevance of the cGMP system in reproductive functions has been recently proposed. Its use was shown to be devoid of effects on semen volume, concentration, sperm membrane integrity or sperm penetration assay. Most available studies demonstrated a significant increase in sperm motility and viability both in vivo and in vitro, which seems to be enhanced at low doses and reduced at high concentrations. Also, these molecules showed a role in capacitation and a debated one concerning acrosome reaction. However, due to the relative short period since the launching of oral PDE5 inhibitors, more investigations should be carried out in wider scales to assess their effect(s) on variant sperm function that could be beneficial as potential therapeutic approaches.
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Affiliation(s)
- T Mostafa
- Department of Andrology & Sexology, Faculty of Medicine, Cairo University, Cairo, Egypt.
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