BACKGROUND: Patients with chronic thromboembolic pulmonary disease (CTED) have persistent pulmonary vascular obstruction and exercise intolerance without pulmonary hypertension at rest and may benefit from pulmonary endarterectomy. However, up to now, CTED has been poorly characterized. OBJECTIVES: This study aimed to analyze the exercise capacity and limiting factors in CTED. METHODS: We compared right heart catheterization and cardiopulmonary exercise test results of patients with CTED [mean pulmonary artery pressure (mPAP) at rest <25 mm Hg, n = 10], chronic thromboembolic pulmonary hypertension (CTEPH, n = 31) and a control group (n = 41) presenting with dyspnea but normal pulmonary vascular imaging and excluded pulmonary hypertension. RESULTS: Subjects with CTED show a reduced oxygen uptake [median 76/interquartile range (IQR) 22% pred.] and work rate (median 76/IQR 21 W). The work rate was significantly lower compared to control subjects (p = 0.04) but not significantly different from CTEPH patients (p = 0.66). Oxygen pulse and breathing reserve were normal. CTED subjects showed decreased end-tidal CO2 at anaerobic threshold (28.4/4.3 mm Hg), an elevated VE/VCO2 slope (42.5/23.5), breathing equivalents (EQO2 32.0/8.7, EQCO2 39.5/8.8), alveolar-capillary oxygen gradient (34.7/15.5 mm Hg) and capillary end-tidal carbon dioxide gradient (8.8/5.7 mm Hg) compared to control subjects (p < 0.001). The degree of limitation was similar to that in CTEPH. CONCLUSIONS: Despite an mPAP of <25 mm Hg, subjects with CTED show objective functional impairment and similar limitations to patients with CTEPH. Functional limitation is characterized by gas exchange disturbance and ineffective ventilation.
BACKGROUND:Patients with chronic thromboembolic pulmonary disease (CTED) have persistent pulmonary vascular obstruction and exercise intolerance without pulmonary hypertension at rest and may benefit from pulmonary endarterectomy. However, up to now, CTED has been poorly characterized. OBJECTIVES: This study aimed to analyze the exercise capacity and limiting factors in CTED. METHODS: We compared right heart catheterization and cardiopulmonary exercise test results of patients with CTED [mean pulmonary artery pressure (mPAP) at rest <25 mm Hg, n = 10], chronic thromboembolic pulmonary hypertension (CTEPH, n = 31) and a control group (n = 41) presenting with dyspnea but normal pulmonary vascular imaging and excluded pulmonary hypertension. RESULTS: Subjects with CTED show a reduced oxygen uptake [median 76/interquartile range (IQR) 22% pred.] and work rate (median 76/IQR 21 W). The work rate was significantly lower compared to control subjects (p = 0.04) but not significantly different from CTEPHpatients (p = 0.66). Oxygen pulse and breathing reserve were normal. CTED subjects showed decreased end-tidal CO2 at anaerobic threshold (28.4/4.3 mm Hg), an elevated VE/VCO2 slope (42.5/23.5), breathing equivalents (EQO2 32.0/8.7, EQCO2 39.5/8.8), alveolar-capillary oxygen gradient (34.7/15.5 mm Hg) and capillary end-tidal carbon dioxide gradient (8.8/5.7 mm Hg) compared to control subjects (p < 0.001). The degree of limitation was similar to that in CTEPH. CONCLUSIONS: Despite an mPAP of <25 mm Hg, subjects with CTED show objective functional impairment and similar limitations to patients with CTEPH. Functional limitation is characterized by gas exchange disturbance and ineffective ventilation.
Authors: Nick H Kim; Marion Delcroix; Xavier Jais; Michael M Madani; Hiromi Matsubara; Eckhard Mayer; Takeshi Ogo; Victor F Tapson; Hossein-Ardeschir Ghofrani; David P Jenkins Journal: Eur Respir J Date: 2019-01-24 Impact factor: 16.671
Authors: Stavros V Konstantinides; Stefano Barco; Stephan Rosenkranz; Mareike Lankeit; Matthias Held; Felix Gerhardt; Leonard Bruch; Ralf Ewert; Martin Faehling; Julia Freise; Hossein-Ardeschir Ghofrani; Ekkehard Grünig; Michael Halank; Nadine Heydenreich; Marius M Hoeper; Hanno H Leuchte; Eckhard Mayer; F Joachim Meyer; Claus Neurohr; Christian Opitz; Antonio Pinto; Hans-Jürgen Seyfarth; Rolf Wachter; Bianca Zäpf; Heinrike Wilkens; Harald Binder; Philipp S Wild Journal: J Thromb Thrombolysis Date: 2016-11 Impact factor: 2.300
Authors: Kim A Ma; Susan R Kahn; Arash Akaberi; Carole Dennie; Christopher Rush; John T Granton; David Anderson; Philip S Wells; Marc A Rodger; Susan Solymoss; Michael J Kovacs; Lawrence Rudski; Avi Shimony; Paul Hernandez; Shawn D Aaron; Elena Pena; Gad Abikhzer; Andrew M Hirsch Journal: Res Pract Thromb Haemost Date: 2018-06-17