Pulmonary vascular responses to exercise: a haemodynamic observation
| Autor: | R. Saggar, G. D. Lewis, D. M. Systrom, H. C. Champion, R. Naeije |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Pulmonary Circulation business.industry Posture Hemodynamics medicine.disease Asymptomatic Pulmonary hypertension Surgery Coronary artery disease medicine.anatomical_structure medicine.artery Internal medicine Pulmonary artery Vascular resistance Cardiology Medicine Humans Clinical significance Vascular Resistance medicine.symptom business Exercise Artery |
| Zdroj: | The European respiratory journal. 39(2) |
| ISSN: | 1399-3003 |
| Popis: | Exercise testing provides additional information over resting variables and is a standard of care in the assessment of coronary artery disease with less subsequent cardiovascular events. In pulmonary hypertension (PH), right ventricular function is clearly an important determinant of survival. However, right ventricular impairment is currently assessed only during resting conditions. Exercise (stress) testing may provide further insight into the complex paradigm of right ventricular dysfunction, right ventricular–left ventricular interdependence and right ventricular–pulmonary artery coupling. Whether pulmonary artery pressure ( P pa)–flow relationships during exercise provides a window into earlier diagnosis of functionally significant PH or adds incrementally to our armamentarium of diagnostic tests and prognostic indicators in PH, is a topic of ongoing investigation. In this issue of the European Respiratory Journal ( ERJ ), the studies by Kovacs et al. [1] and Whyte et al. [2] discuss the potential clinical utility of identifying “normal” and “abnormal” pulmonary vascular response patterns to exercise in patients aged ≤50 yrs. The clinical significance of a hypertensive P pa response to exercise is currently uncertain. It may reflect a normal variant without clinical significance, or it may reflect a bona fide cardiopulmonary limitation and abnormal phenotype. In support of the latter, asymptomatic relatives of individuals with established idiopathic or familial PH have demonstrated an abnormal response to exercise [3]. Few studies have used right heart catheterisation (RHC) to address whether mean P pa ( P pa) >30 mmHg during exercise represents an aberrant pulmonary vascular system in “at-risk” populations [4–11]. Recently, Tolle et al. [9] evaluated a large cohort with exertional dyspnoea who underwent simultaneous cardiopulmonary exercise testing (CPET) and RHC. At maximal exercise, P pa and pulmonary vascular resistance (PVR) were highest, while resting pulmonary arterial hypertension was lowest in … |
| Databáze: | OpenAIRE |
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