Abstract
Assessment of cardiac function during exercise can be technically demanding, making the recovery period a potentially attractive diagnostic window. However, the validity of this approach for exercise pulmonary haemodynamics has not been validated.
The present study, therefore, evaluated directly measured pulmonary haemodynamics during 2-min recovery after maximum invasive cardiopulmonary exercise testing in patients evaluated for unexplained exertional intolerance. Based on peak exercise criteria, patients with exercise pulmonary hypertension (ePH; n=36), exercise pulmonary venous hypertension (ePVH; n=28) and age-matched controls (n=31) were analysed.
By 2-min recovery, 83% (n=30) of ePH patients had a mean pulmonary artery pressure (mPAP) <30 mmHg and 96% (n=27) of ePVH patients had a pulmonary arterial wedge pressure (PAWP) <20 mmHg. Sensitivity of pulmonary hypertension-related haemodynamic measurements during recovery for ePH and ePVH diagnosis was ≤25%. In ePVH, pulmonary vascular compliance (PVC) returned to its resting value by 1-min recovery, while in ePH, elevated pulmonary vascular resistance (PVR) and decreased PVC persisted throughout recovery.
In conclusion, we observed that mPAP and PAWP decay quickly during recovery in ePH and ePVH, compromising the sensitivity of recovery haemodynamic measurements in diagnosing pulmonary hypertension. ePH and ePVH had different PVR and PVC recovery patterns, suggesting differences in the underlying pulmonary hypertension pathophysiology.
Abstract
Pulmonary vascular pressures quickly recover after exercise, but patterns differ between exercise PH and exercise PVH http://ow.ly/ZFGwk
Footnotes
Editorial comment in: Eur Respir J 2016; 48: 18–20.
This article has supplementary material available from erj.ersjournals.com
Support statement: Rudolf K. F. Oliveira receives funds from the São Paulo Research Foundation (FAPESP) (grant number: 2014/12212-5) and from the Brazilian National Council for Scientific and Technological Development (CNPq) (grant number: 232643/2014-8). Roza Badr Eslam receives funds from the Austrian Science Fund (FWF), Erwin Schroedinger (grant number: J3522-B13). Aaron B. Waxman and David M. Systrom are funded by NIH 2R01HL060234-12A1 and U01HL125215-01. Funding information for this article has been deposited with FundRef.
Conflict of interest: None declared.
- Received January 5, 2016.
- Accepted March 17, 2016.
- Copyright ©ERS 2016