State of artCardiopulmonary exercise testing in patients with pulmonary arterial hypertension: An evidence-based review
Section snippets
Link Between PH Pathophysiology and Abnormal CPX Response
The ventilatory expired gas abnormalities precipitated by PH are multifactorial and associated with disease severity.43, 44 Increased pulmonary artery pressure (PAP), the primary pathophysiologic consequence of this condition, creates a ventilation–perfusion mismatch (i.e., acceptable ventilation/diminished perfusion). This results in an increase in physiologic dead space, which, from a ventilatory expired gas perspective, is reflected by an elevated Ve/Vco2 ratio or slope and diminished
Evidence Supporting Utility of CPX in Patients with PH
A literature search was conducted in pubmed using “cardiopulmonary exercise testing” and “pulmonary arterial hypertension” as key phrases. Only studies conducting exercise testing with simultaneous ventilatory expired gas analysis in subjects with a confirmed diagnosis of pulmonary arterial hypertension were included. The 23 presently available investigations addressing this area of research are listed in Table 1. Nineteen of the investigations assessed cohorts with resting pulmonary arterial
Safety of CPX in patients with PH: sub-maximal vs maximal exercise testing
None of the investigations listed in Table 1 reported adverse events with CPX. Similarly, no adverse events with CPX were reported in a small pediatric cohort with PH.72 Severe PH with accompanying syncopal episodes, cardiac arrhythmias or acute right ventricular failure do, however, serve as contraindications to maximal exercise testing.41 Both the Ve/Vco2 ratio and PETco2 demonstrate abnormalities at rest and sub-maximal exercise that are reflective of PH disease severity and potentially
Disclosure Statement
The authors have no conflicts of interest to disclose.
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Quality of Life and the Cardiopulmonary Exercise Test in Pulmonary Arterial Hypertension Patients
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2023, Current Problems in CardiologyCitation Excerpt :In terms of the dependence of aerobic capacity on a robust augmentation of CO from rest to maximal exercise, left ventricular (LV) CO has been the historic focal point.9,10 Patients with pulmonary arterial hypertension (PAH) or secondary pulmonary hypertension (PH) present with a significantly compromised CRF; as pathophysiology worsens, so too does CRF.11–14 Interventions to improve pulmonary hemodynamics continue to emerge and are now a standard of clinical care in several patient populations with increased pulmonary arterial pressure (PAP); new pharmacologic options continue to be explored.
Exercise Rehabilitation Training in Patients With Pulmonary Hypertension: A Review
2022, Heart Lung and CirculationCitation Excerpt :Cardiopulmonary exercise test (CPET) is another important examination to evaluate the exercise capacity of patients with PH. CPET can simultaneously monitor the variables changes in exercise capacity, cardiac function, ventilation efficacy, and gas exchange during exercise. Together with the 6MWD, it provides important information for the diagnosis and prognosis of PH [46]. The important variables of CPET include work rate, workload, heart rate, ventilation (VE), oxygen consumption, carbon dioxide output (VCO2), VE/VCO2 ratio and AT.
Parasympathetic modulation withdrawal improves functional capacity in pulmonary arterial hypertension
2021, Respiratory Physiology and NeurobiologyCitation Excerpt :Previous examinations, such as RHC, vital signs, and clinical information collected in the hospital database, were also considered. The CPET was performed according to the standardization of the American Thoracic Society (ATS)/American College of Chest Physicians to assess the maximal exercise capacity (Arena et al., 2010). All exercise tests were performed on an electromagnetically braked cycle ergometer (Corival®; Lode, Groningen, the Netherlands), with the use of a computer-based breath-by-breath CPET system (Vmax29®-SensorMedics).
Biomarkers in Pulmonary Hypertension
2021, Encyclopedia of Respiratory Medicine, Second Edition