Continuous haemodynamic monitoring during exercise in patients with pulmonary hypertension.
BACKGROUND
Right heart haemodynamic parameters can be recorded continuously with the help of an implanted haemodynamic monitor. Aim of the study was to assess the haemodynamic response with and without inhalation of iloprost during cardiopulmonary exercise testing (CPET) in patients with pulmonary hypertension.


METHODS
Five female patients with documented pulmonary hypertension (mean +/- S.D. age 47 +/- 16 years, 4 arterial, 1 venous) previously implanted with a haemodynamic monitor underwent an incremental exercise test on 2 separate days. The tests were performed before and immediately after inhalation of a single dose of iloprost (17 microg). Parameters recorded by the device were right ventricular (RV)-afterload (RV systolic pressure, RVSP), RV-preload (RV diastolic pressure, RVDP), estimated pulmonary artery diastolic pressure (ePAD), heart rate (HR) and maximum positive rate of RV pressure development (RVdP/dt) (reflecting the dynamic and inotropic state of the RV).


RESULTS
After inhalation of iloprost, RV systolic pressure was always reduced at rest. It was followed by an increase with higher workloads without any difference at VO(2peak). The time course of RV systolic pressure was not linear with a flattening at higher workload during the test. This behaviour was found irrespective of iloprost treatment. The remaining determinants of RV performance showed no relevant differences and a linear behaviour during the exercise test.


CONCLUSIONS
Inhalation of aerosolised iloprost resulted in a reduction in right ventricular pressure at rest but not at maximal workload. The implantable haemodynamic monitor (IHM) may be useful for the evaluation of RV haemodynamics during exercise and in assessing treatment efficacy.
Wonisch
Manfred
M
Department of Medicine, Division of Cardiology, Medical University, Graz, Austria. manfred.wonisch@meduni-graz.at
Fruhwald
Friedrich M
FM
Maier
Robert
R
Watzinger
Norbert
N
Hödl
Ronald
R
Kraxner
Wilfried
W
Perthold
Wolfgang
W
Klein
Werner W
WW
D000328:Adult; D004567:Electrodes, Implanted; D004867:Equipment Design; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D016278:Ventricular Function, Right / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*