☆ 4.2 Article

Differences in Hemodynamic Parameters and Exercise Capacity Between Patients With Pulmonary Arterial Hypertension and Chronic Heart Failure

JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION (2012)

Journal

JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION

Volume 32, Issue 6, Pages 379-385

Publisher

LIPPINCOTT WILLIAMS & WILKINS

DOI: 10.1097/HCR.0b013e318272bc0b

Keywords

chronic heart failure; exercise; pulmonary arterial hypertension; rehabilitation

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Abstract

INTRODUCTION: Although pulmonary arterial hypertension (PAH) and chronic heart failure (CHF) lead to exercise limitation, their pathophysiology is different. Our objective was to evaluate, using right heart catheterization and cardiopulmonary exercise testing, the difference in hemodynamic parameters and exercise capacity between PAH and CHF, which have the same subjective symptoms. METHODS: We studied 20 PAH (mean pulmonary artery pressure: 36 +/- 10 mmHg, all > 25 mmHg) and 20 CHF (ejection fraction: 35 +/- 10%, all < 40%) patients who underwent both cardiopulmonary exercise testing and right heart catheterization. All patients were in New York Heart Association functional class II or III. RESULTS: Peak oxygen uptake ((V) over dotO(2)) was lower for PAH patients than for CHF patients (11.7 +/- 3.2 mL.kg(-1).min(-1) vs 14.5 +/- 4.6 mL.kg(-1).min(-1), P = .03), while the slope of ventilation to carbon dioxide production ratio ((V) over dotE/(V) over dotCO(2)) was higher for PAH patients than for CHF patients (41.0 +/- 12.7 vs 28.0 +/- 9.0, P = .001), despite the similarity in their New York Heart Association functional class. Peak (V) over dotO(2) and (V) over dotE/(V) over dotCO(2) correlated with cardiac index for both groups. An important finding was that peak (V) over dotO(2) correlated with pulmonary vascular resistance for PAH patients (r = -0.46, P = .04) but not for CHF patients (r = 0.33, P = .15). Furthermore, peak (V) over dotO(2) correlated with pulmonary capillary wedge pressure for CHF patients (r = -0.47, P = .03) but not for PAH patients (r = 0.17, P = .47), while the (V) over dotE/(V) over dotCO(2) slope correlated with pulmonary capillary wedge pressure (r = 0.67, P = .002) but not with pulmonary vascular resistance (r = 0.12, P = .63) for CHF patients. CONCLUSION: Peak (V) over dotO(2) and (V) over dotE/(V) over dotCO(2) slope were worse for PAH patients than for CHF patients despite the similar subjective symptoms. This difference might be explained by an altered hemodynamic status.

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Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension: results from a large European multicentre randomized controlled trial

Ekkehard Gruenig, Alison MacKenzie, Andrew J. Peacock, Christina A. Eichstaedt, Nicola Benjamin, Robert Nechwatal, Silvia Ulrich, Stephanie Saxer, Maurizio Bussotti, Marinella Sommaruga, Stefano Ghio, Lina Gumbiene, Egle Paleviciute, Elena Jureviciene, Antonio Cittadini, Anna A. Stanziola, Alberto M. Marra, Gabor Kovacs, Horst Olschewski, Joan-Albert Barbera, Isabel Blanco, Martijn A. Spruit, Frits M. E. Franssen, Anton Vonk Noordegraaf, Abilio Reis, Mario Santos, Sofia Goncalves Viamonte, Heleen Demeyer, Marion Delcroix, Eduardo Bossone, Martin Johnson

Summary: This study demonstrated that exercise training for patients with PAH and CTEPH can significantly improve quality of life, WHO functional class, and peak oxygen consumption, and is feasible, safe, and well-tolerated as an add-on to medical therapy.

EUROPEAN HEART JOURNAL (2021)