title: Cardiopulmonary exercise testing to evaluate the exercise capacity of patients with inoperable chronic thromboembolic pulmonary hypertension: an endothelin receptor antagonist improves the peak PETCO2.
abstract: OBJECTIVE
  The 6-min walking distance is often used for assessing the exercise capacity under the treatment with an endothelin receptor antagonist (ERA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). The cardiopulmonary exercise testing (CPX) was reported to be more useful for the patients with pulmonary arterial hypertension (PAH), however, few reports exist in patients with inoperable CTEPH. The aim of this study was to investigate the effects of an oral dual ERA, bosentan, on exercise capacity using CPX in patients with PAH and inoperable CTEPH.
  
  
  METHODS
  This study included all patients diagnosed with 17 PAH and 12 CTEPH in the World Health Organization functional classes II-IV who started treatment with bosentan therapy. They underwent CPX, which was performed before bosentan therapy and at 3 to 6 months of the treatment.
  
  
  RESULTS
  In PAH patients, peak VO2 significantly increased after the bosentan treatment (p=0.009). On the other hand, in CTEPH patients, there were no significant differences in the peak VO2. However, the peak PETCO2 was significantly increased from 23.9±5.2 mm Hg at baseline to 29.3±10.7 mm Hg after the bosentan treatment (p=0.040). In addition, peak heart rate during exercise tended to decrease after the bosentan therapy (p=0.089).
  
  
  CONCLUSIONS
  Bosentan therapy improved peak PETCO2 but not peak VO2 in patients with inoperable CTEPH. These findings demonstrated that CPX is useful for assessing the exercise capacity of patients with PAH and inoperable CTEPH under the treatment with an ERA.
authors.affiliation: Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirashiki
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Adachi
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakano
authors.affiliation: Department of Rehabilitation Science, Nagoya University Graduate School of Medicine, Nagoya 461-8673, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kono
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan.
authors.forename: Shuzo
authors.initials: S
authors.lastname: Shimazu
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Morimoto
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Okumura
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan.
authors.forename: Kyosuke
authors.initials: K
authors.lastname: Takeshita
authors.affiliation: Department of Rehabilitation Science, Nagoya University Graduate School of Medicine, Nagoya 461-8673, Japan.
authors.forename: Sumio
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan.
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
authors.affiliation: Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan. Electronic address: takahisa@med.nagoya-u.ac.jp.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kondo
mesh_terms: D000077300:Bosentan; D002245:Carbon Dioxide / Q000378:metabolism*; D065128:Endothelin Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology* / Q000601:surgery; D013449:Sulfonamides / Q000494:pharmacology / Q000627:therapeutic use; D014463:Ultrasonography; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D065128:Endothelin Receptor Antagonists; D013449:Sulfonamides; D002245:Carbon Dioxide; D000077300:Bosentan; D010100:Oxygen
keywords: Cardiopulmonary exercise testing; Chronic thromboembolic pulmonary hypertension; Endothelin receptor antagonist; Pulmonary arterial hypertension