Associations of Exercise Tolerance With Hemodynamic Parameters for Pulmonary Arterial Hypertension and for Chronic Thromboembolic Pulmonary Hypertension
Associations of Exercise Tolerance With Hemodynamic Parameters for Pulmonary Arterial Hypertension and for Chronic Thromboembolic Pulmonary Hypertension
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DOI：
10.1097/hcr.0000000000000257
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发表时间：
2017-09-01
影响因子：
3.8
通讯作者：
Hirata, Ken-ichi
中科院分区：
文献类型：
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作者：
Tsuboi, Yasunori;Tanaka, Hidekazu;Hirata, Ken-ichi
目的：肺动脉高压（PAH）和慢性血栓栓塞性肺动脉高压（CTEPH）是肺动脉高压（PH）的主要亚组。尽管病因不同，但这两种疾病的特点都是血管重塑，导致进行性右心衰竭。无创定期评估运动耐量变得越来越重要。现在推荐使用心肺运动试验 (CPET) 和 6 分钟步行试验 (6MWT) 来评估运动耐量，但对于 PAH 和 CTEPH 患者的运动耐量与右心导管插入术 (RHC) 数据之间可能存在的差异知之甚少。方法：对 57 名 PH 患者（24 名 PAH 和 33 名 CTEPH）进行了回顾性研究，所有患者均接受了超声心动图、CPET、结果：对于 PAH 和 CTEPH 患者，CPET 期间的峰值心率显着高于 6MWT，而 CPET 和 6MWT 期间的最低外周血氧饱和度相似。对于 PAH 患者，峰值 V o(2) 与心脏指数 (CI) 之间（r = 0.59；P = .002）以及 V-E/Vo(2) 斜率与 CI 之间（r = - 0.46，P = .02）之间观察到显着相关性，并且峰值 V o 2 与肺血管阻力 (PVR) 以及 V-E/Vo(2) 和 PVR 之间存在非显着相关趋势（r =分别为-0.39；P = 0.05；r = 0.39；然而，对于 CTEPH 患者，仅观察到 V-E/Vo(2) 斜率与 CI 之间存在显着相关性（r = -0.38；P = .02）。 结论：评估运动耐量时应考虑 PH 病因，而 CPET 除了通过 RHC 进行血流动力学评估外，在随访期间定期评估也很有效。
Purpose: Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are the main subgroups of pulmonary hypertension (PH). Despite differences in their etiologies, both diseases are characterized by vascular remodeling, resulting in progressive right heart failure. Noninvasive periodic evaluation of exercise tolerance has become increasingly important. Cardiopulmonary exercise testing (CPET) and a 6-minute walk test (6MWT) are now both recommended for evaluating exercise tolerance, but there is insufficient knowledge about possible differences in the associations of exercise tolerance with right heart catheterization (RHC) data for patients with PAH and CTEPH.Methods: A retrospective study was performed with 57 patients with PH (24 with PAH and 33 with CTEPH) all of whom underwent echocardiography, CPET, 6MWT, and RHC.Results: For both patients with PAH and CTEPH, peak heart rate during CPET was significantly higher than that from 6MWT, whereas minimum peripheral oxygen saturation during CPET and 6MWT was similar. For patients with PAH, significant correlations were observed between peak V o(2) and cardiac index (CI) (r = 0.59; P = .002) and between V-E/Vo(2) slopes and CI (r = - 0.46, P = .02), as well as a nonsignificant correlation tendency for peak V o 2 and pulmonary vascular resistance (PVR) and for V-E/Vo(2) and PVR (r = -0.39; P = .05; and r = 0.39; P = .06, respectively). For patients with CTEPH, however, a significant correlation was observed only between V-E/Vo(2) slopes and CI (r = -0.38; P = .02).Conclusion: PH etiology should be considered when assessing exercise tolerance, whereas CPET can be effective in addition to hemodynamic assessment by means of RHC for periodic evaluation during followup.