Pulmonary vascular response patterns during exercise in left ventricular systolic dysfunction predict exercise capacity and outcomes
Elevated resting pulmonary arterial pressure (PAP) in patients with left ventricular systolic dysfunction (LVSD) purports a poor prognosis. However, PAP response patterns to exercise in LVSD and their relationship to functional capacity and outcomes have not been characterized. Sixty consecutive pat...
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| Veröffentlicht in: | Circulation. Heart failure 2011-05, Vol.4 (3), p.276-285 |
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| creator | Lewis, Gregory D Murphy, Ryan M Shah, Ravi V Pappagianopoulos, Paul P Malhotra, Rajeev Bloch, Kenneth D Systrom, David M Semigran, Marc J |
| description | Elevated resting pulmonary arterial pressure (PAP) in patients with left ventricular systolic dysfunction (LVSD) purports a poor prognosis. However, PAP response patterns to exercise in LVSD and their relationship to functional capacity and outcomes have not been characterized.
Sixty consecutive patients with LVSD (age 60±12 years, left ventricular ejection fraction 0.31±0.07, mean±SD) and 19 controls underwent maximum incremental cardiopulmonary exercise testing with simultaneous hemodynamic monitoring. During low-level exercise (30 W), LVSD subjects, compared with controls, had greater augmentation in mean PAPs (15±1 versus 5±1 mm Hg), transpulmonary gradients (5±1 versus 1±1 mm Hg), and effective pulmonary artery elastance (0.05±0.02 versus -0.03±0.01 mm Hg/mL, P |
| doi_str_mv | 10.1161/CIRCHEARTFAILURE.110.959437 |
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Sixty consecutive patients with LVSD (age 60±12 years, left ventricular ejection fraction 0.31±0.07, mean±SD) and 19 controls underwent maximum incremental cardiopulmonary exercise testing with simultaneous hemodynamic monitoring. During low-level exercise (30 W), LVSD subjects, compared with controls, had greater augmentation in mean PAPs (15±1 versus 5±1 mm Hg), transpulmonary gradients (5±1 versus 1±1 mm Hg), and effective pulmonary artery elastance (0.05±0.02 versus -0.03±0.01 mm Hg/mL, P<0.0001 for all). A linear increment in PAP relative to work (0.28±0.12 mm Hg/W) was observed in 65% of LVSD patients, which exceeded that observed in controls (0.07±0.02 mm Hg/W, P<0.0001). Exercise capacity and survival was worse in patients with a PAP/watt slope above the median than in patients with a lower slope. In the remaining 35% of LVSD patients, exercise induced a steep initial increment in PAP (0.41±0.16 mm Hg/W) followed by a plateau. The plateau pattern, compared with a linear pattern, was associated with reduced peak Vo(2) (10.6±2.6 versus 13.1±4.0 mL · kg(-1) · min(-1), P=0.005), lower right ventricular stroke work index augmentation with exercise (5.7±3.8 versus 9.7±5.0 g/m(2), P=0.002), and increased mortality (hazard ratio 8.1, 95% CI 2.7 to 23.8, P<0.001).
A steep increment in PAP during exercise and failure to augment PAP throughout exercise are associated with decreased exercise capacity and survival in patients with LVSD, and may therefore represent therapeutic targets.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00309790.</description><identifier>ISSN: 1941-3289</identifier><identifier>EISSN: 1941-3297</identifier><identifier>DOI: 10.1161/CIRCHEARTFAILURE.110.959437</identifier><identifier>PMID: 21292991</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Exercise Test ; Exercise Tolerance ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Pulmonary Artery - physiopathology ; Pulmonary Circulation - physiology ; Pulmonary Veins - physiopathology ; Systole ; Ventricular Dysfunction, Left - physiopathology</subject><ispartof>Circulation. Heart failure, 2011-05, Vol.4 (3), p.276-285</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494t-946ed6510e112608dc30a865ef7611857393b0a53e135dfa7a139b218ea22b1e3</citedby><cites>FETCH-LOGICAL-c494t-946ed6510e112608dc30a865ef7611857393b0a53e135dfa7a139b218ea22b1e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,3674,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21292991$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lewis, Gregory D</creatorcontrib><creatorcontrib>Murphy, Ryan M</creatorcontrib><creatorcontrib>Shah, Ravi V</creatorcontrib><creatorcontrib>Pappagianopoulos, Paul P</creatorcontrib><creatorcontrib>Malhotra, Rajeev</creatorcontrib><creatorcontrib>Bloch, Kenneth D</creatorcontrib><creatorcontrib>Systrom, David M</creatorcontrib><creatorcontrib>Semigran, Marc J</creatorcontrib><title>Pulmonary vascular response patterns during exercise in left ventricular systolic dysfunction predict exercise capacity and outcomes</title><title>Circulation. Heart failure</title><addtitle>Circ Heart Fail</addtitle><description>Elevated resting pulmonary arterial pressure (PAP) in patients with left ventricular systolic dysfunction (LVSD) purports a poor prognosis. However, PAP response patterns to exercise in LVSD and their relationship to functional capacity and outcomes have not been characterized.
Sixty consecutive patients with LVSD (age 60±12 years, left ventricular ejection fraction 0.31±0.07, mean±SD) and 19 controls underwent maximum incremental cardiopulmonary exercise testing with simultaneous hemodynamic monitoring. During low-level exercise (30 W), LVSD subjects, compared with controls, had greater augmentation in mean PAPs (15±1 versus 5±1 mm Hg), transpulmonary gradients (5±1 versus 1±1 mm Hg), and effective pulmonary artery elastance (0.05±0.02 versus -0.03±0.01 mm Hg/mL, P<0.0001 for all). A linear increment in PAP relative to work (0.28±0.12 mm Hg/W) was observed in 65% of LVSD patients, which exceeded that observed in controls (0.07±0.02 mm Hg/W, P<0.0001). Exercise capacity and survival was worse in patients with a PAP/watt slope above the median than in patients with a lower slope. In the remaining 35% of LVSD patients, exercise induced a steep initial increment in PAP (0.41±0.16 mm Hg/W) followed by a plateau. The plateau pattern, compared with a linear pattern, was associated with reduced peak Vo(2) (10.6±2.6 versus 13.1±4.0 mL · kg(-1) · min(-1), P=0.005), lower right ventricular stroke work index augmentation with exercise (5.7±3.8 versus 9.7±5.0 g/m(2), P=0.002), and increased mortality (hazard ratio 8.1, 95% CI 2.7 to 23.8, P<0.001).
A steep increment in PAP during exercise and failure to augment PAP throughout exercise are associated with decreased exercise capacity and survival in patients with LVSD, and may therefore represent therapeutic targets.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00309790.</description><subject>Aged</subject><subject>Exercise Test</subject><subject>Exercise Tolerance</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Pulmonary Artery - physiopathology</subject><subject>Pulmonary Circulation - physiology</subject><subject>Pulmonary Veins - physiopathology</subject><subject>Systole</subject><subject>Ventricular Dysfunction, Left - physiopathology</subject><issn>1941-3289</issn><issn>1941-3297</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUcFqGzEQXUpLkyb5hSLooSenGmmlXVEoGOM0BkOKSc5C1s6mKrvSVtKa-N4P7wanbpLTDG_eezPMK4pPQC8BJHxZrDaL6-V8c3s1X63vNssJpZdKqJJXb4pTUCXMOFPV22Nfq5PiQ0q_KJVMCPW-OGHAFFMKTos_P8auD97EPdmZZMfORBIxDcEnJIPJGaNPpBmj8_cEHzBaNw2cJx22mezQ5-gOqrRPOXTOkmaf2tHb7IInQ8TG2fxfac1grMt7YnxDwpht6DGdF-9a0yW8eKpnxd3V8nZxPVvffF8t5uuZLVWZZ6qU2EgBFAGYpHVjOTW1FNhWEqAWFVd8S43gCFw0rakMcLVlUKNhbAvIz4pvB99h3PbY2MfrTaeH6PrpAToYp19OvPup78NO86qkDORk8PnJIIbfI6ase5csdp3xGMaka1lVDKpaTMyvB6aNIaWI7XELUP0Yo34d44RSfYhxUn98fuhR-y83_hcZPKCF</recordid><startdate>20110501</startdate><enddate>20110501</enddate><creator>Lewis, Gregory D</creator><creator>Murphy, Ryan M</creator><creator>Shah, Ravi V</creator><creator>Pappagianopoulos, Paul P</creator><creator>Malhotra, Rajeev</creator><creator>Bloch, Kenneth D</creator><creator>Systrom, David M</creator><creator>Semigran, Marc J</creator><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>7X8</scope><scope>5PM</scope></search><sort><creationdate>20110501</creationdate><title>Pulmonary vascular response patterns during exercise in left ventricular systolic dysfunction predict exercise capacity and outcomes</title><author>Lewis, Gregory D ; Murphy, Ryan M ; Shah, Ravi V ; Pappagianopoulos, Paul P ; Malhotra, Rajeev ; Bloch, Kenneth D ; Systrom, David M ; Semigran, Marc J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-946ed6510e112608dc30a865ef7611857393b0a53e135dfa7a139b218ea22b1e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Exercise Test</topic><topic>Exercise Tolerance</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>Pulmonary Artery - physiopathology</topic><topic>Pulmonary Circulation - physiology</topic><topic>Pulmonary Veins - physiopathology</topic><topic>Systole</topic><topic>Ventricular Dysfunction, Left - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lewis, Gregory D</creatorcontrib><creatorcontrib>Murphy, Ryan M</creatorcontrib><creatorcontrib>Shah, Ravi V</creatorcontrib><creatorcontrib>Pappagianopoulos, Paul P</creatorcontrib><creatorcontrib>Malhotra, Rajeev</creatorcontrib><creatorcontrib>Bloch, Kenneth D</creatorcontrib><creatorcontrib>Systrom, David M</creatorcontrib><creatorcontrib>Semigran, Marc J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Circulation. Heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lewis, Gregory D</au><au>Murphy, Ryan M</au><au>Shah, Ravi V</au><au>Pappagianopoulos, Paul P</au><au>Malhotra, Rajeev</au><au>Bloch, Kenneth D</au><au>Systrom, David M</au><au>Semigran, Marc J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pulmonary vascular response patterns during exercise in left ventricular systolic dysfunction predict exercise capacity and outcomes</atitle><jtitle>Circulation. Heart failure</jtitle><addtitle>Circ Heart Fail</addtitle><date>2011-05-01</date><risdate>2011</risdate><volume>4</volume><issue>3</issue><spage>276</spage><epage>285</epage><pages>276-285</pages><issn>1941-3289</issn><eissn>1941-3297</eissn><abstract>Elevated resting pulmonary arterial pressure (PAP) in patients with left ventricular systolic dysfunction (LVSD) purports a poor prognosis. However, PAP response patterns to exercise in LVSD and their relationship to functional capacity and outcomes have not been characterized.
Sixty consecutive patients with LVSD (age 60±12 years, left ventricular ejection fraction 0.31±0.07, mean±SD) and 19 controls underwent maximum incremental cardiopulmonary exercise testing with simultaneous hemodynamic monitoring. During low-level exercise (30 W), LVSD subjects, compared with controls, had greater augmentation in mean PAPs (15±1 versus 5±1 mm Hg), transpulmonary gradients (5±1 versus 1±1 mm Hg), and effective pulmonary artery elastance (0.05±0.02 versus -0.03±0.01 mm Hg/mL, P<0.0001 for all). A linear increment in PAP relative to work (0.28±0.12 mm Hg/W) was observed in 65% of LVSD patients, which exceeded that observed in controls (0.07±0.02 mm Hg/W, P<0.0001). Exercise capacity and survival was worse in patients with a PAP/watt slope above the median than in patients with a lower slope. In the remaining 35% of LVSD patients, exercise induced a steep initial increment in PAP (0.41±0.16 mm Hg/W) followed by a plateau. The plateau pattern, compared with a linear pattern, was associated with reduced peak Vo(2) (10.6±2.6 versus 13.1±4.0 mL · kg(-1) · min(-1), P=0.005), lower right ventricular stroke work index augmentation with exercise (5.7±3.8 versus 9.7±5.0 g/m(2), P=0.002), and increased mortality (hazard ratio 8.1, 95% CI 2.7 to 23.8, P<0.001).
A steep increment in PAP during exercise and failure to augment PAP throughout exercise are associated with decreased exercise capacity and survival in patients with LVSD, and may therefore represent therapeutic targets.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00309790.</abstract><cop>United States</cop><pmid>21292991</pmid><doi>10.1161/CIRCHEARTFAILURE.110.959437</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged Exercise Test Exercise Tolerance Female Humans Male Middle Aged Prognosis Pulmonary Artery - physiopathology Pulmonary Circulation - physiology Pulmonary Veins - physiopathology Systole Ventricular Dysfunction, Left - physiopathology |
| title | Pulmonary vascular response patterns during exercise in left ventricular systolic dysfunction predict exercise capacity and outcomes |
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