title: Pulmonary arterial compliance and exercise capacity after pulmonary endarterectomy.
abstract: Patients with chronic thromboembolic pulmonary hypertension (CTEPH), despite successful pulmonary endarterectomy (PEA), can continue to suffer from a limitation in exercise capacity. The objective of this study was to assess whether pulmonary arterial compliance is a predictor of exercise capacity after PEA. Right heart haemodynamics, treadmill incremental exercise test, spirometry, carbon monoxide transfer factor, arterial blood gas and echocardiographic examinations were retrospectively analysed in a population of CTEPH patients who underwent PEA at a single centre. Baseline and 3-month haemodynamic data were available in 296 patients; 5-year follow-up data were available in 68 patients. In a multivariable model the following parameters were found to be independent predictors of exercise capacity after surgery: age, sex, pulmonary arterial compliance, tricuspid annular plane excursion, arterial oxygen tension and carbon monoxide transfer factor (p<0.0001); the model showed good discrimination (Harrell's c=0.84) and calibration (shrinkage coefficient=0.91). Poor exercise capacity at 3 months was loosely associated with higher death rate during subsequent survival (Harrell's c=0.61). In conclusion, after successful PEA, reduced pulmonary arterial compliance is an important determinant of exercise capacity in association with the age and sex of the patients, and the extent of recovery of both cardiac and respiratory function. However, exercise capacity does not explain a large proportion of the effect of surgery on subsequent survival.
authors.affiliation: Fondazione IRCCS Policlinico San Matteo, Pavia.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghio
authors.forename: Marco
authors.initials: M
authors.lastname: Morsolini
authors.forename: Angelo
authors.initials: A
authors.lastname: Corsico
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Gabriella
authors.initials: G
authors.lastname: Mattiucci
authors.forename: Claudia
authors.initials: C
authors.lastname: Raineri
authors.forename: Laura
authors.initials: L
authors.lastname: Scelsi
authors.forename: Nicola
authors.initials: N
authors.lastname: Vistarini
authors.forename: Luigi
authors.initials: L
authors.lastname: Oltrona Visconti
authors.forename: Andrea Maria
authors.initials: AM
authors.lastname: D'Armini
mesh_terms: D000368:Aged; D004691:Endarterectomy / Q000379:methods*; D015444:Exercise; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy*; D008170:Lung Compliance; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D011379:Prognosis; D011651:Pulmonary Artery / Q000503:physiopathology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome