Functional Impact of Pulmonary Hypertension due to Hypoventilation and Changes under NIPPV

Abstract

We aimed to characterize the association of pulmonary hypertension due to hypoventilation and exercise capacity, and the haemodynamic and functional changes under non-invasive ventilation.

A retrospective analysis was done to assess haemodynamics and functional capacity in 18 patients with daytime pulmonary hypertension due to hypoventilation at baseline and after three months of non-invasive ventilation.

Patients presented with a mean pulmonary artery pressure of 49±13 mmHg, preserved cardiac index (3.2±0.66 l·min⁻¹·m⁻²), six-minute walking distance of 303±134 m, and severely elevated NT-proBNP levels. Mean pulmonary artery pressure correlated negatively with maximum work rate (R=−0.72, p=0.03) and six-minute walking distance (R=−0.62, p=0.01). Following non-invasive ventilation we found a significant reduction of mean pulmonary artery pressure (−18 mmHg, p=<0.001), NT-proBNP levels (−2110 pg·mL⁻¹, p=0.001), improvement in the six-minute walking distance (+66 m, p=0.008), and maximum work rate (+18 W, p=0.028). Changes in work rate correlated inversely to pulmonary artery pressure. (R= −0.75, p=0.031).

In this specific cohort with hypoventilation and severe PH, pulmonary hypertension was associated with reduced exercise capacity. Following non-invasive ventilation, haemodynamics and exercise capacity improved significantly.