Exercise-induced pulmonary hypertension in patients after successful pulmonary endarterectomy
D. Bonderman, R. Hitsch, A. Martischnig, N. Skoro-Sajer, M. Kneussl, W. Klepetko, I. M. Lang (Vienna, Austria)
Source: Annual Congress 2006 - Pulmonary hypertension: thromo-embolic processes
Session: Pulmonary hypertension: thromo-embolic processes
Session type: Thematic Poster Session
Number: 2363
Disease area: Pulmonary vascular diseases
Abstract Background: Pulmonary endarterectomy (PEA) provides potential cure for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Successfully operated patients have been shown to normalize exercise capacity and hemodynamic parameters in long-term studies. Methods: To investigate whether pulmonary hypertension can be provoked by exercise, we studied patients at least one year after successful PEA with documented (near-) normalization of exercise capacity and hemodynamics. Patients (n=13) and age-matched non–pulmonary hypertensive controls (n=14) underwent echocardiography at submaximal treadmill exercise. Results: Resting mean pulmonary arterial pressure was 25±9 mmHg, mean pulmonary vascular resistance was 291±148 dynesxsxcm-5, mixed venous saturation was 71±5% and mean cardiac output was 5.2±1.1 l/min at 63±31 (range 16-120) months after PEA. There was no difference in age (61±10 vs. 57±13 years, p=0.5) or 6-minute walking distance (489±114 vs. 456±45 meters, p=0.32) between patients and controls. While the difference in resting systolic pulmonary arterial pressures (sPAP) reached only borderline significance (41±18 vs. 30±6 mmHg, p=0.05), there was a significant difference in exercise-sPAP (71±23 vs. 46±11 mmHg, p=0.001), resting pulmonic valve acceleration time (102±24 vs. 132±17 ms, p=0.0008) and serum BNP levels (207±134 vs. 70±77 pg/ml, p=0.007). Conclusions: Patients with normal exercise capacity and resting hemodynamics after PEA demonstrate significant pulmonary hypertension at exercise. There is a need for studies investigating whether this patient population does additionally benefit from vasodilator therapies.
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D. Bonderman, R. Hitsch, A. Martischnig, N. Skoro-Sajer, M. Kneussl, W. Klepetko, I. M. Lang (Vienna, Austria). Exercise-induced pulmonary hypertension in patients after successful pulmonary endarterectomy. Eur Respir J 2006; 28: Suppl. 50, 2363
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