TY - JOUR
T1 - Submaximal Exercise Pulmonary Gas Exchange in Left Heart Disease Patients with Different Forms of Pulmonary Hypertension
AU - Taylor, Bryan J.
AU - Smetana, Michael R.
AU - Frantz, Robert P.
AU - Johnson, Bruce D.
N1 - Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background We determined whether pulmonary gas exchange indices during submaximal exercise are different in heart failure (HF) patients with combined post- and pre-capillary pulmonary hypertension (PPC-PH) versus HF patients with isolated post-capillary PH (IPC-PH) or no PH. Methods and Results Pulmonary hemodynamics and pulmonary gas exchange were assessed during rest and submaximal exercise in 39 HF patients undergoing right heart catheterization. After hemodynamic evaluation, patients were classified as having no PH (n = 11), IPC-PH (n = 12), or PPC-PH (n = 16). At an equivalent oxygen consumption, end-tidal CO2 (PETCO2) and arterial oxygen saturation (SaO2) were greater in no-PH and IPC-PH versus PPC-PH patients (36.1 ± 3.2 vs 31.7 ± 4.5 vs 26.2 ± 4.7 mm Hg and 97 ± 2 vs 96 ± 3 vs 91 ± 1%, respectively). Conversely, dead-space ventilation (VD/VT) and the ventilatory equivalent for carbon dioxide (VE/VCO2ratio) were lower in no-PH and IPC-PH versus PPC-PH patients (0.37 ± 0.05 vs 0.38 ± 0.04 vs 0.47 ± 0.03 and 38 ± 5 vs 42 ± 8 vs 51 ± 8, respectively). The exercise-induced change in VD/VT, VE/VCO2 ratio, and PETCO2 correlated significantly with the change in mean pulmonary arterial pressure, diastolic pressure difference, and transpulmonary pressure gradient in PPC-PH patients only. Conclusions Noninvasive pulmonary gas exchange indices during submaximal exercise are different in HF patients with combined post- and pre-capillary PH compared with patients with isolated post-capillary PH or no PH.
AB - Background We determined whether pulmonary gas exchange indices during submaximal exercise are different in heart failure (HF) patients with combined post- and pre-capillary pulmonary hypertension (PPC-PH) versus HF patients with isolated post-capillary PH (IPC-PH) or no PH. Methods and Results Pulmonary hemodynamics and pulmonary gas exchange were assessed during rest and submaximal exercise in 39 HF patients undergoing right heart catheterization. After hemodynamic evaluation, patients were classified as having no PH (n = 11), IPC-PH (n = 12), or PPC-PH (n = 16). At an equivalent oxygen consumption, end-tidal CO2 (PETCO2) and arterial oxygen saturation (SaO2) were greater in no-PH and IPC-PH versus PPC-PH patients (36.1 ± 3.2 vs 31.7 ± 4.5 vs 26.2 ± 4.7 mm Hg and 97 ± 2 vs 96 ± 3 vs 91 ± 1%, respectively). Conversely, dead-space ventilation (VD/VT) and the ventilatory equivalent for carbon dioxide (VE/VCO2ratio) were lower in no-PH and IPC-PH versus PPC-PH patients (0.37 ± 0.05 vs 0.38 ± 0.04 vs 0.47 ± 0.03 and 38 ± 5 vs 42 ± 8 vs 51 ± 8, respectively). The exercise-induced change in VD/VT, VE/VCO2 ratio, and PETCO2 correlated significantly with the change in mean pulmonary arterial pressure, diastolic pressure difference, and transpulmonary pressure gradient in PPC-PH patients only. Conclusions Noninvasive pulmonary gas exchange indices during submaximal exercise are different in HF patients with combined post- and pre-capillary PH compared with patients with isolated post-capillary PH or no PH.
KW - Diastolic pressure difference
KW - pre- and post-capillary pulmonary hypertension
KW - right-heart catheterization
KW - submaximal exercise
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U2 - 10.1016/j.cardfail.2015.04.003
DO - 10.1016/j.cardfail.2015.04.003
M3 - Article
C2 - 25887446
AN - SCOPUS:84938293007
SN - 1071-9164
VL - 21
SP - 647
EP - 655
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 8
ER -