Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging.
Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging.
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DOI：
10.1186/s12968-020-00664-6
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发表时间：
2020-10-12
期刊：
影响因子：
--
通讯作者：
Rajagopalan S
中科院分区：
文献类型：
--
作者：
Patterson AJ;Sarode A;Al-Kindi S;Shaver L;Thomas R;Watson E;Alaiti MA;Liu Y;Hamilton J;Seiberlich N;Rashid I;Gilkeson R;Schilz R;Hoit B;Jenkins T;Zullo M;Bossone E;Longenecker C;Simonetti O;Rajagopalan S
人类免疫缺陷病毒 (HIV) 患者通常会出现呼吸困难，其直接原因可能并不总是显而易见。在这项针对运动受限的 HIV 患者的前瞻性队列研究中，我们使用心肺运动测试 (CPET) 结合运动心血管磁共振 (CMR) 来阐明呼吸困难的病因。 34 名接受抗逆转录病毒治疗且出现呼吸困难和运动受限的 HIV 患者（49.7 岁，65% 男性，平均绝对 CD4 计数 700）接受了结合休息和最大运动跑步机 CMR 和 CPET 的综合评估。总体平均耗氧量 (VO2) 峰值降低至 23.2 ± 6.9 ml/kg/min，其中 20 名患者（占整个队列的 58.8%）达到呼吸交换比 > 1。通气效率 (VE)/VCO2 斜率升高至 36 ± 7.92，而通气储备（VE：最大通气量 (MVV)）在正常范围内。平均绝对右心室 (RV) 和左心室 (LV) 收缩储备分别保持在 9.0% ± 11.2 和 9.4% ± 9.4。平均静息和运动后平均肺动脉流速分别为 12.2 ± 3.9 cm/s 和 18.9 ± 8.3，这表明缺乏运动引起的肺动脉高血压 (PAH)。在 5 名患者中发现了 LV 而不是 RV 延迟增强。相关分析发现收缩性 RV 或 LV 储备的峰值 VO2 测量值之间没有关系，但 LV 和 RV 每搏输出量与 PET CO2 相关 (p = 0.02，p = 0.03)。治疗良好的 HIV 感染者似乎具有保守的右心室和左心室功能、收缩储备，并且没有运动诱发 PAH 的证据。然而，我们发现通气受损的证据表明呼吸困难的非心肺病因。
Human Immunodeficiency Virus (HIV) patients commonly experience dyspnea for which an immediate cause may not be always apparent. In this prospective cohort study of HIV patients with exercise limitation, we use cardiopulmonary exercise testing (CPET) coupled with exercise cardiovascular magnetic resonance (CMR) to elucidate etiologies of dyspnea. Thirty-four HIV patients on antiretroviral therapy with dyspnea and exercise limitation (49.7 years, 65% male, mean absolute CD4 count 700) underwent comprehensive evaluation with combined rest and maximal exercise treadmill CMR and CPET. The overall mean oxygen consumption (VO2) peak was reduced at 23.2 ± 6.9 ml/kg/min with 20 patients (58.8% of overall cohort) achieving a respiratory exchange ratio > 1. The ventilatory efficiency (VE)/VCO2 slope was elevated at 36 ± 7.92, while ventilatory reserve (VE: maximal voluntary ventilation (MVV)) was within normal limits. The mean absolute right ventricular (RV) and left ventricular (LV) contractile reserves were preserved at 9.0% ± 11.2 and 9.4% ± 9.4, respectively. The average resting and post-exercise mean average pulmonary artery velocities were 12.2 ± 3.9 cm/s and 18.9 ± 8.3 respectively, which suggested lack of exercise induced pulmonary artery hypertension (PAH). LV but not RV delayed enhancement were identified in five patients. Correlation analysis found no relationship between peak VO2 measures of contractile RV or LV reserve, but LV and RV stroke volume correlated with PET CO2 (p = 0.02, p = 0.03). Well treated patients with HIV appear to have conserved RV and LV function, contractile reserve and no evidence of exercise induced PAH. However, we found evidence of impaired ventilation suggesting a non-cardiopulmonary etiology for dyspnea.
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影响因子：
3.3
作者：
Lin, Hung-Yu;Bender, Jacob A.;Ding, Yu;Chung, Yiu-Cho;Hinton, Alice M.;Pennell, Michael L.;Whitehead, Kevin K.;Raman, Subha V.;Simonetti, Orlando P.
通讯作者：
Simonetti, Orlando P.
影响因子：
5.7
作者：
Barnett, Christopher F.;Hsue, Priscilla Y.
通讯作者：
Hsue, Priscilla Y.
影响因子：
3.7
作者：
Groepenhoff, Herman;Vonk-Noordegraaf, Anton;Bogaard, Harm J.
通讯作者：
Bogaard, Harm J.
影响因子：
14
作者：
Swift, Andrew J.;Rajaram, Smitha;Kiely, David G.
通讯作者：
Kiely, David G.
DOI：
10.1186/s12968-014-0079-8
发表时间：
2014-10-01
期刊：
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
影响因子：
--
作者：
Aandal G;Nadig V;Yeh V;Rajiah P;Jenkins T;Sattar A;Griswold M;Gulani V;Gilkeson RC;Seiberlich N
通讯作者：
Seiberlich N