title: Diagnosis of CTEPH versus IPAH using capillary to end-tidal carbon dioxide gradients.
abstract: Chronic thromboembolic pulmonary hypertension (CTEPH) represents an important differential diagnosis to idiopathic pulmonary arterial hypertension (IPAH). We hypothesised that the capillary to end-tidal carbon dioxide gradient at rest and during exercise might help differentiate CTEPH from IPAH. Patients who presented with unequivocal IPAH or CTEPH according to ventilation/perfusion scanning, pulmonary angiography, computed tomography and right heart catheterisation were included in this retrospective study and compared with healthy controls. 21 IPAH patients and 16 CTEPH patients fulfilled the inclusion criteria. Haemodynamics and peak oxygen uptake were comparable, but respiratory rates at rest and during exercise were significantly higher in CTEPH than in IPAH. End-tidal carbon dioxide was significantly lower in CTEPH versus IPAH at rest and during exercise, while capillary carbon dioxide values were similar. Correspondingly, capillary to end-tidal carbon dioxide gradients were significantly increased in CTEPH versus IPAH at rest and during exercise (median (range) 8.6 (3.0-13.7) versus 4.4 (0.9-9.0) (p<0.001) and 9.3 (3.3-13.1) versus 4.1 (0.0-8.8) mmHg (p<0.001), respectively). Although these values were closer to normal in IPAH they were still significantly elevated compared with healthy controls (2.3 (-4.8-8.1) and -1.9 (-5.7-6.2) mmHg, respectively). Capillary to end-tidal carbon dioxide gradients may help to distinguish CTEPH from IPAH based on resting and exercise values.
authors: Division of Pulmonology, Dept of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: S J
authors: SJ
authors: Scheidl
authors: C
authors: C
authors: Englisch
authors: G
authors: G
authors: Kovacs
authors: F
authors: F
authors: Reichenberger
authors: R
authors: R
authors: Schulz
authors: A
authors: A
authors: Breithecker
authors: H-A
authors: HA
authors: Ghofrani
authors: W
authors: W
authors: Seeger
authors: H
authors: H
authors: Olschewski
mesh_terms: D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis / Q000379:methods; D002245:Carbon Dioxide / Q000378:metabolism*; D002908:Chronic Disease; D005080:Exercise Test / Q000379:methods; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D015272:Pulmonary Medicine / Q000379:methods*; D012189:Retrospective Studies; D013147:Spirometry / Q000379:methods; D013923:Thromboembolism / Q000175:diagnosis* / Q000503:physiopathology; D013990:Tidal Volume
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen