Stephen P Wright1, Sam Esfandiari1, Taylor Gray2, Felipe C Fuchs3, Anjala Chelvanathan3, William Chan3, Zion Sasson3, John T Granton4, Jack M Goodman5, Susanna Mak1. 1. Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada. 2. Department of Exercise Sciences, University of Toronto, Toronto, Ontario, Canada. 3. Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada. 4. Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Respirology, University Health Network, Toronto, Ontario, Canada. 5. Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada Department of Exercise Sciences, University of Toronto, Toronto, Ontario, Canada.
Abstract
OBJECTIVES: The clinical and prognostic significance of 'exaggerated' elevations in pulmonary artery wedge pressure (PAWP) during symptom-limited exercise testing is increasingly recognised. However, the paucity of normative data makes the identification of abnormal responses challenging. Our objectives was to describe haemodynamic responses that reflect normal adaptation to submaximal exercise in a group of community-dwelling, older, non-dyspnoeic adults. METHODS: Twenty-eight healthy volunteers (16 men/12 women; 55±6 years) were studied during rest and two consecutive stages of cycle ergometry, at targeted heart rates of 100 bpm (light exercise) and 120 bpm (moderate exercise). Right-heart catheterisation was performed to measure pulmonary artery pressures, both early (2 min) and after sustained (7 min) exercise at each intensity. RESULTS: End-expiratory PAWP at baseline was 11±3 mm Hg and increased to 22±5 mm Hg at early-light exercise (p<0.01). At sustained-light exercise, PAWP declined to 17±5 mm Hg, remaining elevated versus baseline (p<0.01). PAWP increased again at early-moderate exercise to 20±6 mm Hg but did not exceed the values observed at early-light exercise, and declined further to 15±5 mm Hg at sustained-moderate exercise (p<0.01 vs baseline). When analysed at 30 s intervals, mean and diastolic pulmonary artery pressures peaked at 180 (IQR=30) s and 130 (IQR=90) s, respectively, and both declined significantly by 420 (IQR=30) s (both p<0.01) of light exercise. Similar temporal patterns were observed at moderate exercise. CONCLUSIONS: The range of PAWP responses to submaximal exercise is broad in health, but also time-variant. PAWP may routinely exceed 20 mm Hg early in exercise. Initial increases in PAWP and mean pulmonary artery pressures do not necessarily reflect abnormal cardiopulmonary physiology, as pressures may normalise within a period of minutes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
OBJECTIVES: The clinical and prognostic significance of 'exaggerated' elevations in pulmonary artery wedge pressure (PAWP) during symptom-limited exercise testing is increasingly recognised. However, the paucity of normative data makes the identification of abnormal responses challenging. Our objectives was to describe haemodynamic responses that reflect normal adaptation to submaximal exercise in a group of community-dwelling, older, non-dyspnoeic adults. METHODS: Twenty-eight healthy volunteers (16 men/12 women; 55±6 years) were studied during rest and two consecutive stages of cycle ergometry, at targeted heart rates of 100 bpm (light exercise) and 120 bpm (moderate exercise). Right-heart catheterisation was performed to measure pulmonary artery pressures, both early (2 min) and after sustained (7 min) exercise at each intensity. RESULTS: End-expiratory PAWP at baseline was 11±3 mm Hg and increased to 22±5 mm Hg at early-light exercise (p<0.01). At sustained-light exercise, PAWP declined to 17±5 mm Hg, remaining elevated versus baseline (p<0.01). PAWP increased again at early-moderate exercise to 20±6 mm Hg but did not exceed the values observed at early-light exercise, and declined further to 15±5 mm Hg at sustained-moderate exercise (p<0.01 vs baseline). When analysed at 30 s intervals, mean and diastolic pulmonary artery pressures peaked at 180 (IQR=30) s and 130 (IQR=90) s, respectively, and both declined significantly by 420 (IQR=30) s (both p<0.01) of light exercise. Similar temporal patterns were observed at moderate exercise. CONCLUSIONS: The range of PAWP responses to submaximal exercise is broad in health, but also time-variant. PAWP may routinely exceed 20 mm Hg early in exercise. Initial increases in PAWP and mean pulmonary artery pressures do not necessarily reflect abnormal cardiopulmonary physiology, as pressures may normalise within a period of minutes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: William M Oldham; Rudolf K F Oliveira; Rui-Sheng Wang; Alexander R Opotowsky; David M Rubins; Jon Hainer; Bradley M Wertheim; George A Alba; Gaurav Choudhary; Adrienn Tornyos; Calum A MacRae; Joseph Loscalzo; Jane A Leopold; Aaron B Waxman; Horst Olschewski; Gabor Kovacs; David M Systrom; Bradley A Maron Journal: Circ Res Date: 2018-02-05 Impact factor: 17.367
Authors: Natasha R Girdharry; Robert F Bentley; Felipe H Valle; Elizabeth Karvasarski; Sinan Osman; Vikram Gurtu; Shimon Kolker; Susanna Mak Journal: CJC Open Date: 2021-04-30
Authors: Susanna Mak; Shimon Kolker; Natasha R Girdharry; Robert F Bentley; Felipe H Valle; Vikram Gurtu; K H Mok; Jakov Moric; John Thenganatt; John T Granton Journal: Pulm Circ Date: 2022-07-01 Impact factor: 2.886
Authors: Robert F Bentley; Madeleine Barker; Sam Esfandiari; Stephen P Wright; Felipe H Valle; John T Granton; Susanna Mak Journal: J Am Heart Assoc Date: 2020-11-06 Impact factor: 5.501
Authors: Katarina Zeder; Chiara Banfi; Gregor Steinrisser-Allex; Bradley A Maron; Marc Humbert; Gregory D Lewis; Andrea Berghold; Horst Olschewski; Gabor Kovacs Journal: Eur Respir J Date: 2022-10-13 Impact factor: 33.795