Right ventricular load at exercise is a cause of persistent exercise limitation in patients with normal resting pulmonary vascular resistance after pulmonary endarterectomy.
BACKGROUND
Pulmonary endarterectomy (PEA) provides a potential cure for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, successfully operated patients can continue to suffer from a limitation of exercise capacity, despite normalization of pulmonary vascular resistance (PVR). The purpose of the present study was to explore the cardiopulmonary exercise test (CPET) profile and the pulmonary hemodynamic response to exercise in these patients.


METHODS
Thirteen successfully operated patients with CTEPH and persistent dyspnea and control subjects underwent a CPET and a right-sided heart catheterization at rest and during exercise.


RESULTS
The CPET profile of the patients was characterized by mild hyperventilation and decreased peak oxygen uptake (VO2). While there were no differences in resting hemodynamics between patients and control subjects, PVR was higher in the patients after 10 min of exercise (111 ± 46 dynes/s/cm(5) vs 71 ± 42 dynes/s/cm(5), P = .04), and pulmonary arterial compliance (Ca) was lower (5.5 ± 2.3 mL/mm Hg vs 8.1 ± 3.5 mL/mm Hg, P = .048). Ca under exercise correlated with peak VO2 in the patients (R(2) = 0.825, P = .022).


CONCLUSIONS
After successful PEA, patients with persistent exertional dyspnea display an abnormal pulmonary hemodynamic response to exercise, characterized by increased PVR and decreased Ca. Decreased Ca under exercise is a strong predictor of limited exercise capacity in these patients.
Bonderman
Diana
D
Department of Cardiology, Medical University of Vienna, Vienna, Austria.
Martischnig
Amadea M
AM
Vonbank
Karin
K
Nikfardjam
Mariam
M
Meyer
Brigitte
B
Heinz
Gottfried
G
Klepetko
Walter
W
Naeije
Robert
R
Lang
Irene M
IM
D006328:Cardiac Catheterization; D004691:Endarterectomy; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011651:Pulmonary Artery / Q000503:physiopathology* / Q000601:surgery; D011655:Pulmonary Embolism / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011669:Pulmonary Wedge Pressure; D012146:Rest; D012189:Retrospective Studies; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*