Pulmonary Hemodynamic Response to Exercise in Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy
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...
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| Veröffentlicht in: | Respiration 2015-01, Vol.90 (1), p.63-73 |
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| creator | Richter, Manuel Jonas Sommer, Natascha Gall, Henning Voswinckel, Robert Seeger, Werner Mayer, Eckhard Wiedenroth, Christoph B. Rieth, Andreas Grimminger, Friedrich Guth, Stefan Ghofrani, Hossein A. |
| description | 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. |
| doi_str_mv | 10.1159/000398815 |
| format | Article |
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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.</description><identifier>ISSN: 0025-7931</identifier><identifier>EISSN: 1423-0356</identifier><identifier>DOI: 10.1159/000398815</identifier><identifier>PMID: 26044754</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Aged ; Arterial Pressure ; Basic Science Investigations ; Blood clots ; Cardiac Catheterization ; Care and treatment ; Chronic Disease ; Cohort Studies ; Complications and side effects ; Development and progression ; Endarterectomy ; Exercise ; Exercise - physiology ; Exercise Test ; Exercise therapy ; Female ; Hemodynamics - physiology ; Humans ; Hypertension ; Hypertension, Pulmonary - etiology ; Hypertension, Pulmonary - physiopathology ; Hypertension, Pulmonary - surgery ; Male ; Medical prognosis ; Middle Aged ; Patient outcomes ; Pulmonary Artery - physiopathology ; Pulmonary Artery - surgery ; Pulmonary Circulation - physiology ; Pulmonary Embolism - complications ; Pulmonary Embolism - physiopathology ; Pulmonary Embolism - surgery ; Pulmonary hypertension ; Retrospective Studies ; Risk factors ; Thoracic surgery ; Treatment Outcome ; Vascular Resistance</subject><ispartof>Respiration, 2015-01, Vol.90 (1), p.63-73</ispartof><rights>2015 S. Karger AG, Basel</rights><rights>COPYRIGHT 2015 S. Karger AG</rights><rights>Copyright (c) 2015 S. Karger AG, Basel</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c569t-28a991692bb0863b8b2eaa18f8faaac8e66f4e98951f852180b899802e3f627e3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,2425,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26044754$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Richter, Manuel Jonas</creatorcontrib><creatorcontrib>Sommer, Natascha</creatorcontrib><creatorcontrib>Gall, Henning</creatorcontrib><creatorcontrib>Voswinckel, Robert</creatorcontrib><creatorcontrib>Seeger, Werner</creatorcontrib><creatorcontrib>Mayer, Eckhard</creatorcontrib><creatorcontrib>Wiedenroth, Christoph B.</creatorcontrib><creatorcontrib>Rieth, Andreas</creatorcontrib><creatorcontrib>Grimminger, Friedrich</creatorcontrib><creatorcontrib>Guth, Stefan</creatorcontrib><creatorcontrib>Ghofrani, Hossein A.</creatorcontrib><title>Pulmonary Hemodynamic Response to Exercise in Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy</title><title>Respiration</title><addtitle>Respiration</addtitle><description>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.</description><subject>Aged</subject><subject>Arterial Pressure</subject><subject>Basic Science Investigations</subject><subject>Blood clots</subject><subject>Cardiac Catheterization</subject><subject>Care and treatment</subject><subject>Chronic Disease</subject><subject>Cohort Studies</subject><subject>Complications and side effects</subject><subject>Development and progression</subject><subject>Endarterectomy</subject><subject>Exercise</subject><subject>Exercise - physiology</subject><subject>Exercise Test</subject><subject>Exercise therapy</subject><subject>Female</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension, Pulmonary - etiology</subject><subject>Hypertension, Pulmonary - physiopathology</subject><subject>Hypertension, Pulmonary - surgery</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Patient outcomes</subject><subject>Pulmonary Artery - physiopathology</subject><subject>Pulmonary Artery - surgery</subject><subject>Pulmonary Circulation - physiology</subject><subject>Pulmonary Embolism - complications</subject><subject>Pulmonary Embolism - physiopathology</subject><subject>Pulmonary Embolism - surgery</subject><subject>Pulmonary hypertension</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Thoracic surgery</subject><subject>Treatment Outcome</subject><subject>Vascular Resistance</subject><issn>0025-7931</issn><issn>1423-0356</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqF0U9rFDEUAPAgil2rB-8iAwXRw2j-TJKXY1lWKxRapJ5DZvalO3UmWZMZcD9Av7cpuy6lFw_hJeSX98h7hLxl9DNj0nyhlAoDwOQzsmANFzUVUj0nC0q5rLUR7IS8yvmOUiYB-EtywhVtGi2bBbm_nocxBpd21QWOcb0Lbuy76gfmbQwZqylWqz-Yur7s-1AtNymGcn9T4thGLGsox0dJdltME4bcx1C16GPCyoV15fyE6ZFbhbUrLmE3xXH3mrzwbsj45hBPyc-vq5vlRX159e378vyy7qQyU83BGcOU4W1LQYkWWo7OMfDgnXMdoFK-QQNGMg-SM6AtGAOUo_CKaxSn5OM-7zbF3zPmyY597nAYXMA4Z8vAaKEV0Ob_VD3UAQW60LMn9C7OKZSPWKap1AASaFEf9urWDWg36IZpk-MwT6VT2Z4roZlqQJgCP-1hl2LOCb3dpn4sTbOM2od52-O8i31_KD23I66P8t-AC3i3B79cusV0BIf3fwGNTa64</recordid><startdate>20150101</startdate><enddate>20150101</enddate><creator>Richter, Manuel Jonas</creator><creator>Sommer, Natascha</creator><creator>Gall, Henning</creator><creator>Voswinckel, Robert</creator><creator>Seeger, Werner</creator><creator>Mayer, Eckhard</creator><creator>Wiedenroth, Christoph B.</creator><creator>Rieth, Andreas</creator><creator>Grimminger, Friedrich</creator><creator>Guth, Stefan</creator><creator>Ghofrani, Hossein A.</creator><general>S. Karger AG</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RQ</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>U9A</scope><scope>7X8</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope></search><sort><creationdate>20150101</creationdate><title>Pulmonary Hemodynamic Response to Exercise in Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy</title><author>Richter, Manuel Jonas ; Sommer, Natascha ; Gall, Henning ; Voswinckel, Robert ; Seeger, Werner ; Mayer, Eckhard ; Wiedenroth, Christoph B. ; Rieth, Andreas ; Grimminger, Friedrich ; Guth, Stefan ; Ghofrani, Hossein A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c569t-28a991692bb0863b8b2eaa18f8faaac8e66f4e98951f852180b899802e3f627e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Arterial Pressure</topic><topic>Basic Science Investigations</topic><topic>Blood clots</topic><topic>Cardiac Catheterization</topic><topic>Care and treatment</topic><topic>Chronic Disease</topic><topic>Cohort Studies</topic><topic>Complications and side effects</topic><topic>Development and progression</topic><topic>Endarterectomy</topic><topic>Exercise</topic><topic>Exercise - physiology</topic><topic>Exercise Test</topic><topic>Exercise therapy</topic><topic>Female</topic><topic>Hemodynamics - physiology</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension, Pulmonary - etiology</topic><topic>Hypertension, Pulmonary - physiopathology</topic><topic>Hypertension, Pulmonary - surgery</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>Patient outcomes</topic><topic>Pulmonary Artery - physiopathology</topic><topic>Pulmonary Artery - surgery</topic><topic>Pulmonary Circulation - physiology</topic><topic>Pulmonary Embolism - complications</topic><topic>Pulmonary Embolism - physiopathology</topic><topic>Pulmonary Embolism - surgery</topic><topic>Pulmonary hypertension</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Thoracic surgery</topic><topic>Treatment Outcome</topic><topic>Vascular Resistance</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Richter, Manuel Jonas</creatorcontrib><creatorcontrib>Sommer, Natascha</creatorcontrib><creatorcontrib>Gall, Henning</creatorcontrib><creatorcontrib>Voswinckel, Robert</creatorcontrib><creatorcontrib>Seeger, Werner</creatorcontrib><creatorcontrib>Mayer, Eckhard</creatorcontrib><creatorcontrib>Wiedenroth, Christoph B.</creatorcontrib><creatorcontrib>Rieth, Andreas</creatorcontrib><creatorcontrib>Grimminger, Friedrich</creatorcontrib><creatorcontrib>Guth, Stefan</creatorcontrib><creatorcontrib>Ghofrani, Hossein A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Career & Technical Education Database</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Respiration</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Richter, Manuel Jonas</au><au>Sommer, Natascha</au><au>Gall, Henning</au><au>Voswinckel, Robert</au><au>Seeger, Werner</au><au>Mayer, Eckhard</au><au>Wiedenroth, Christoph B.</au><au>Rieth, Andreas</au><au>Grimminger, Friedrich</au><au>Guth, Stefan</au><au>Ghofrani, Hossein A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pulmonary Hemodynamic Response to Exercise in Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy</atitle><jtitle>Respiration</jtitle><addtitle>Respiration</addtitle><date>2015-01-01</date><risdate>2015</risdate><volume>90</volume><issue>1</issue><spage>63</spage><epage>73</epage><pages>63-73</pages><issn>0025-7931</issn><eissn>1423-0356</eissn><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.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>26044754</pmid><doi>10.1159/000398815</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Arterial Pressure Basic Science Investigations Blood clots Cardiac Catheterization Care and treatment Chronic Disease Cohort Studies Complications and side effects Development and progression Endarterectomy Exercise Exercise - physiology Exercise Test Exercise therapy Female Hemodynamics - physiology Humans Hypertension Hypertension, Pulmonary - etiology Hypertension, Pulmonary - physiopathology Hypertension, Pulmonary - surgery Male Medical prognosis Middle Aged Patient outcomes Pulmonary Artery - physiopathology Pulmonary Artery - surgery Pulmonary Circulation - physiology Pulmonary Embolism - complications Pulmonary Embolism - physiopathology Pulmonary Embolism - surgery Pulmonary hypertension Retrospective Studies Risk factors Thoracic surgery Treatment Outcome Vascular Resistance |
| title | Pulmonary Hemodynamic Response to Exercise in Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy |
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