[Cardiopulmonary exercise testing in exercise-induced pulmonary hypertension].
OBJECTIVE
To determine the accuracy of cardiopulmonary exercise-testing (CPET) in detecting exercise-induced pulmonary hypertension.


BACKGROUND
CPET plays a key role in the investigation of exertional breathlessness. Exercise-induced pulmonary hypertension has been recently demonstrated to be a cause of exertional dyspnea. However, the features of CPET associated with the condition are still unknown.


METHODS
We prospectively studied CPET and exercise echo-cardiography characteristics in 39 patients complaining of exertional breathlessness. Patients could be divided into 3 groups as follows: 1) control subjects having normal pulmonary arterial pressure at rest [pulmonary arterial systolic pressure < 35 mmHg] and at peak exercise [pulmonary arterial systolic pressure < 45 mmHg]; 2) patients having exercise-induced PH; 3) patients having resting PH. Results from CPET have been analyzed within each group.


RESULTS
Patients developing exercise-induced PH revealed an increased VD/VT ratio and CO2 gradient (P[a-ET]CO2) at peak exercise compared to controls (VD/VT at 0.38 +/- 0.1 vs 0.29 +/- 0.11 and P[a-ET]CO2 at 4,6 +/- 3,1 vs 1 +/- 3,8 mmHg). VD/VT and P[a-ET]CO2 were increased in patients with resting PH. A VD/VT ratio at peak exercise higher than 0.34 was 72.7% sensitive and 71% specific in predicting exercise-induced PH. Positive and negative predictive values were 72.7% and 70.1% respectively.


CONCLUSIONS
Patients with exercise-induced PH did not decrease or may increase dead space during exercise. Therefore CPET may be a useful tool in selecting patients who need to undergo further exercise haemodynamic investigations.
Chenivesse
C
C
Clinique des Maladies Respiratoires, Hôpital Calmette, CHRU Lille, France.
Rachenne
V
V
Fournier
C
C
Leroy
S
S
Nevière
R
R
Le Tourneau
T
T
Wallaert
B
B
D000222:Adaptation, Physiological; D000328:Adult; D000332:Aerobiosis; D000368:Aged; D001944:Breath Tests; D002245:Carbon Dioxide / Q000032:analysis; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D004562:Electrocardiography; D015444:Exercise; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D007773:Lactates / Q000097:blood; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000032:analysis; D010313:Partial Pressure; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012126:Respiratory Dead Space / Q000502:physiology*; D012146:Rest; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000503:physiopathology
D007773:Lactates; D002245:Carbon Dioxide; D010100:Oxygen