Marco Vicenzi1, Gael Deboeck2, Vitalie Faoro3, Juliane Loison3, Jean-Luc Vachiery1, Robert Naeije4. 1. Erasme University Hospital, Department of Cardiology, Université Libre de Bruxelles, Bruxelles, Belgium. 2. Erasme University Hospital, Department of Cardiology, Université Libre de Bruxelles, Bruxelles, Belgium; Faculty of Motor Sciences, Department of Physiology, Université Libre de Bruxelles, Bruxelles, Belgium. 3. Faculty of Motor Sciences, Department of Physiology, Université Libre de Bruxelles, Bruxelles, Belgium. 4. Erasme University Hospital, Department of Cardiology, Université Libre de Bruxelles, Bruxelles, Belgium; Faculty of Motor Sciences, Department of Physiology, Université Libre de Bruxelles, Bruxelles, Belgium. Electronic address: rnaeije@ulb.ac.be.
Abstract
BACKGROUND: Patients with pulmonary arterial hypertension (PAH) and with heart failure (HF) have increased ventilatory responses to exercise in proportion to disease severity. Exercise-associated oscillatory ventilation (EOV) predicts poor outcome in HF. Whether EOV occurs in PAH is unknown. METHODS: We analyzed the initial cardiopulmonary exercise tests (CPETs) and right heart catheterization data of 109 patients with PAH and in 107 patients with HF consecutively referred to our center. RESULTS: The PAH patients were aged 54±16 years and their NYHA functional class was 2.8±0.5. The HF patients were aged 53±13 years and NYHA 2.4±0.6. Hemodynamic data were obtained in only 36 of them. The patients with PAH compared to those with HF had a lower peak VO2 (13±5 vs 17±5 mL/kg/min, p<0.001) and a higher ventilatory equivalent for CO2 (VE/VCO2) slope (55±21 vs 34±7, p<0.001). Mean pulmonary artery pressure was higher (50±10 vs 29±11 mmHg) and wedge pressure lower (10±3 vs 19±5 mmHg) in PAH patients, but cardiac output was not different (4.0±1.3 vs 4.2±1.2L/min). EOV was present in 22 patients (21%) with HF and in no patient with PAH. CONCLUSIONS: Patients with PAH compared to HF with slightly better functional class have a lower aerobic exercise capacity and higher ventilatory responses, but no EOV. An increase in pulmonary artery wedge pressure rather than a low cardiac output may be necessary condition of EOV in HF.
BACKGROUND:Patients with pulmonary arterial hypertension (PAH) and with heart failure (HF) have increased ventilatory responses to exercise in proportion to disease severity. Exercise-associated oscillatory ventilation (EOV) predicts poor outcome in HF. Whether EOV occurs in PAH is unknown. METHODS: We analyzed the initial cardiopulmonary exercise tests (CPETs) and right heart catheterization data of 109 patients with PAH and in 107 patients with HF consecutively referred to our center. RESULTS: The PAH patients were aged 54±16 years and their NYHA functional class was 2.8±0.5. The HF patients were aged 53±13 years and NYHA 2.4±0.6. Hemodynamic data were obtained in only 36 of them. The patients with PAH compared to those with HF had a lower peak VO2 (13±5 vs 17±5 mL/kg/min, p<0.001) and a higher ventilatory equivalent for CO2 (VE/VCO2) slope (55±21 vs 34±7, p<0.001). Mean pulmonary artery pressure was higher (50±10 vs 29±11 mmHg) and wedge pressure lower (10±3 vs 19±5 mmHg) in PAH patients, but cardiac output was not different (4.0±1.3 vs 4.2±1.2L/min). EOV was present in 22 patients (21%) with HF and in no patient with PAH. CONCLUSIONS:Patients with PAH compared to HF with slightly better functional class have a lower aerobic exercise capacity and higher ventilatory responses, but no EOV. An increase in pulmonary artery wedge pressure rather than a low cardiac output may be necessary condition of EOV in HF.
Authors: Marco Vicenzi; Sergio Caravita; Irene Rota; Rosa Casella; Gael Deboeck; Lorenzo Beretta; Andrea Lombi; Jean-Luc Vachiery Journal: PLoS One Date: 2022-05-19 Impact factor: 3.752
Authors: Gabriel D Rodrigues; Marco Vicenzi; Chiara Bellocchi; Lorenzo Beretta; Angelica Carandina; Eleonora Tobaldini; Stefano Carugo; Nicola Montano Journal: Front Cardiovasc Med Date: 2022-07-01