title: Impact of pulmonary hypertension on gas exchange and exercise capacity in patients with pulmonary fibrosis.
abstract: Pulmonary hypertension is a relevant interceding morbidity in patients with pulmonary fibrosis that has significant impact on exercise tolerance and outcome. The aim of this study was to further characterize the exercise intolerance, dyspnoea and ventilatory inefficiency of patients with pulmonary fibrosis in the presence or absence of pulmonary hypertension via cardiopulmonary exercise testing. Thirty-four patients underwent pulmonary function testing, symptom-limited exercise testing on a bicycle and dyspnoea evaluation according to the BORG scale. Pulmonary hypertension was assessed by echocardiography and in a subset of patient's right heart catheterization. Sixteen of 34 patients with pulmonary fibrosis revealed pulmonary hypertension. While all study patients did not differ in lung functions and demographic characteristics, patients suffering from pulmonary hypertension showed a significantly impaired exercise tolerance and worsened ventilatory inefficiency. The extent of pulmonary artery pressure elevation impacted significantly on ventilatory inefficiency. In addition, the increased ventilatory requirements significantly influenced the extent of dyspnoea in patients with pulmonary hypertension. We conclude that pulmonary hypertension has a significant impact on exercise capacity and dyspnoea in patients with interstitial lung disease (ILD). The further impairment of exercise capacity as well as the extent of dyspnoea in patients with interceding PHT is attributable to a significantly impaired ventilatory inefficiency.
authors.affiliation: Division of Pulmonary Medicine and Infectious Diseases, University of Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany. glaeser.sven@gmail.com
authors.forename: Sven
authors.initials: S
authors.lastname: Gläser
authors.forename: Oliver
authors.initials: O
authors.lastname: Noga
authors.forename: Beate
authors.initials: B
authors.lastname: Koch
authors.forename: Christian F
authors.initials: CF
authors.lastname: Opitz
authors.forename: Bernd
authors.initials: B
authors.lastname: Schmidt
authors.forename: Bettina
authors.initials: B
authors.lastname: Temmesfeld
authors.forename: Marcus
authors.initials: M
authors.lastname: Dörr
authors.forename: Ralf
authors.initials: R
authors.lastname: Ewert
authors.forename: Christoph
authors.initials: C
authors.lastname: Schäper
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D014463:Ultrasonography