title: Functional impact of pulmonary hypertension due to hypoventilation and changes under noninvasive ventilation.
abstract: We aimed to characterise the association of pulmonary hypertension due to hypoventilation and exercise capacity, and the haemodynamic and functional changes under noninvasive ventilation. A retrospective analysis was carried out to assess haemodynamics and functional capacity in 18 patients with daytime pulmonary hypertension, due to hypoventilation, at baseline and after 3 months of noninvasive ventilation. Patients presented with a mean±SD pulmonary artery pressure of 49±13 mmHg, preserved cardiac index (3.2±0.66 L·min(-1)·m(-2)), 6-min walking distance of 303±134 m and severely elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Mean pulmonary artery pressure correlated negatively with maximum work rate (R= -0.72; p=0.03) and 6-min walking distance (R= -0.62; p=0.01). Following noninvasive ventilation we found a significant reduction of mean pulmonary artery pressure (-18 mmHg; p<0.001) and NT-proBNP levels (-2110 pg·mL(-1); p=0.001), and improvement in the 6-min walking distance (+66 m; p=0.008) and maximum work rate (+18 W; p=0.028). Changes in work rate correlated inversely with pulmonary artery pressure (R= -0.75; p=0.031). In this specific cohort with hypoventilation and severe pulmonary hypertension, pulmonary hypertension was associated with reduced exercise capacity. Following noninvasive ventilation, haemodynamics and exercise capacity improved significantly.
authors.affiliation: Medical Mission Hospital, Academic Teaching Hospital, Julius Maximilian University of Würzburg, Würzburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Held
authors.forename: Johanna
authors.initials: J
authors.lastname: Walthelm
authors.forename: Stefan
authors.initials: S
authors.lastname: Baron
authors.forename: Christine
authors.initials: C
authors.lastname: Roth
authors.forename: Berthold
authors.initials: B
authors.lastname: Jany
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D015331:Cohort Studies; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D007040:Hypoventilation / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D010845:Obesity Hypoventilation Syndrome / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D011175:Positive-Pressure Respiration; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology*; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D014797:Vital Capacity