Exercise capacity in idiopathic pulmonary fibrosis: The effect of pulmonary hypertension
Exercise capacity in idiopathic pulmonary fibrosis: The effect of pulmonary hypertension
复制标题
DOI：
10.1111/j.1440-1843.2010.01909.x
复制
发表时间：
2011-04-01
期刊：
影响因子：
6.9
通讯作者：
Stanopoulos, Ioannis
中科院分区：
文献类型：
--
作者：
Boutou, Afroditi K.;Pitsiou, Georgia G.;Stanopoulos, Ioannis
背景和目的：IPF患者肺动脉压（PAP）升高通常与肺功能受损并存。关于肺动脉高压（PH）对IPF患者运动期间心肺反应影响的数据非常有限。我们试图调查PH对运动能力的影响，以及收缩期PAP（sPAP）和肺功能测试之间的相关性，以及心肺运动参数，IPF和PH患者。方法：回顾性研究了连续81例IPF患者，他们在6年的时间内进行了评估。患者接受肺功能检查、多普勒超声心动图和最大心肺运动试验。结果：57%的患者被诊断为肺动脉高压（PH）。根据PH的严重程度对患者进行分类，结果表明，sPAP > 50 mm Hg的患者最大做功率、最大摄氧量、无氧阈值和最大氧脉搏均显著降低。在伴有PH的IPF患者中，sPAP与最大摄氧量、无氧阈、最大氧脉搏和无氧阈时呼气末CO2浓度相关，而与无氧阈时CO2呼气当量相关性最强（r = 0.611，P < 0.001）。有肺功能或运动参数指示肺容量减少，在不同的患者类别，没有这些参数与sPAP.Conclusions：PH有IPF患者的运动能力的负面影响。在伴有PH的IPF患者中，静息sPAP与提示气体交换和循环障碍的运动参数相关，但与肺力学缺陷无关。
Background and objective: Increased pulmonary arterial pressure (PAP) usually coexists with impaired lung function in IPF. Data on the effect of pulmonary hypertension (PH) on cardiopulmonary responses during exercise in IPF patients is very limited. We sought to investigate the impact of PH on exercise capacity and the correlation between systolic PAP (sPAP) and pulmonary function testing, as well as cardiopulmonary exercise parameters, in patients with IPF and PH.Methods: Eighty-one consecutive patients with IPF, who were evaluated over a 6-year period, were retrospectively studied. Patients underwent pulmonary function testing, Doppler echocardiography and maximal cardiopulmonary exercise testing. PH was defined as sPAP > 35 mm Hg.Results: PH was diagnosed in 57% of the patients. Categorization of patients according to severity of PH indicated a significant reduction in maximum work rate, peak O-2 uptake, anaerobic threshold and peak O-2 pulse in those with sPAP > 50 mm Hg. In IPF patients with PH, estimated sPAP correlated with peak O-2 uptake, anaerobic threshold, peak O-2 pulse and end-tidal CO2 at anaerobic threshold, while the strongest correlation was between sPAP and ventilatory equivalent for CO2 at anaerobic threshold (r = 0.611, P < 0.001). There were no differences in pulmonary function or exercise parameters indicative of lung volume reduction, across the patient categories, and none of these parameters correlated with sPAP.Conclusions: PH has a negative impact on exercise capacity in IPF patients. In IPF patients with PH, resting sPAP correlated with exercise parameters indicative of gas exchange and circulatory impairment, but not with defective lung mechanics.