title: Pulmonary Hemodynamic Response to Exercise in Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy.
abstract: BACKGROUND
  Pulmonary endarterectomy (PEA) is the treatment of choice in surgically accessible chronic thromboembolic pulmonary hypertension (CTEPH). An important predictor of outcome is postsurgical residual pulmonary hypertension.
  
  
  OBJECTIVE
  We aimed to use the hemodynamic response during exercise before PEA as a measurement for the hemodynamic outcome 1 year after PEA.
  
  
  METHODS
  Between January 2011 and December 2013, 299 patients underwent PEA in our center. A total of 16 patients who were assessed by means of invasive hemodynamic measurements during exercise both at baseline and 1 year after PEA were retrospectively analyzed.
  
  
  RESULTS
  Pre-PEA mean pulmonary arterial pressure (mPAP) increased during exercise from 35.8 ± 7.6 to 53.8 ± 5.1 mm Hg, diastolic pulmonary arterial pressure (dPAP) from 21.5 ± 5.6 to 30.3 ± 9.6 mm Hg, cardiac output (CO) from 4.4 ± 0.8 to 6.5 ± 1.9 l/min and diastolic pulmonary gradient (DPG) from 14.6 ± 4.9 to 20.7 ± 12.7 mm Hg. Post-PEA mPAP increased from 23.7 ± 6.6 at rest to 43.2 ± 7.1 mm Hg, while CO increased to a higher extent from 5.1 ± 0.9 to 8.4 ± 1.9 l/min. There were significant correlations between pre-PEA DPG/CO and dPAP/CO slopes with the pulmonary vascular resistance (Spearman r = 0.578, p = 0.019, and r = 0.547, p = 0.028) and mPAP at rest after PEA (Spearman r = 0.581, p = 0.018, and r = 0.546, p = 0.028).
  
  
  CONCLUSIONS
  In CTEPH, the presurgical dynamic DPG/CO and dPAP/CO slopes during submaximal exercise are associated with the hemodynamic outcome 1 year after PEA.
authors.affiliation: Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.
authors.forename: Manuel Jonas
authors.initials: MJ
authors.lastname: Richter
authors.forename: Natascha
authors.initials: N
authors.lastname: Sommer
authors.forename: Henning
authors.initials: H
authors.lastname: Gall
authors.forename: Robert
authors.initials: R
authors.lastname: Voswinckel
authors.forename: Werner
authors.initials: W
authors.lastname: Seeger
authors.forename: Eckhard
authors.initials: E
authors.lastname: Mayer
authors.forename: Christoph B
authors.initials: CB
authors.lastname: Wiedenroth
authors.forename: Andreas
authors.initials: A
authors.lastname: Rieth
authors.forename: Friedrich
authors.initials: F
authors.lastname: Grimminger
authors.forename: Stefan
authors.initials: S
authors.lastname: Guth
authors.forename: Hossein A
authors.initials: HA
authors.lastname: Ghofrani
mesh_terms: D000368:Aged; D062186:Arterial Pressure; D006328:Cardiac Catheterization; D002908:Chronic Disease; D015331:Cohort Studies; D004691:Endarterectomy; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation / Q000502:physiology*; D011655:Pulmonary Embolism / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014655:Vascular Resistance