Exercise pulmonary hypertension in chronic thromboembolic pulmonary disease: A right heart catheterization study
Abstract Many patients with chronic thromboembolic pulmonary disease (CTEPD) suffer from exertional dyspnea. It is unclear if CTEPD is associated with exercise pulmonary hypertension (ePH). This cross‐sectional study aimed to determine the occurrence of ePH in patients with CTEPD and to identify the...
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| Format: | Article |
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Wiley
2024-10-01
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| Series: | Pulmonary Circulation |
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| Online Access: | https://doi.org/10.1002/pul2.70018 |
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| author | Adam Dhayyat Janne Mykland Hilde Øyvind Jervan Diyar Rashid Jostein Gleditsch Knut Stavem Waleed Ghanima Kjetil Steine |
| author_facet | Adam Dhayyat Janne Mykland Hilde Øyvind Jervan Diyar Rashid Jostein Gleditsch Knut Stavem Waleed Ghanima Kjetil Steine |
| author_sort | Adam Dhayyat |
| collection | DOAJ |
| description | Abstract Many patients with chronic thromboembolic pulmonary disease (CTEPD) suffer from exertional dyspnea. It is unclear if CTEPD is associated with exercise pulmonary hypertension (ePH). This cross‐sectional study aimed to determine the occurrence of ePH in patients with CTEPD and to identify the haemodynamic changes during exercise. We recruited 36 patients with persistent dyspnoea and residual perfusion defects by ventilation/perfusion scintigraphy from a large cohort of patients with previous pulmonary embolism. All patients underwent exercise right heart catheterization before being classified into the following groups: (1) CTEPD without ePH; comprising patients with normal mean pulmonary artery pressure (mPAP) of ≤20 mmHg, but with mPAP/cardiac output (CO) slope of ≤3 mmHg/L/min, (2) CTEPD with ePH (CTEPD‐ePH); those with CTEPD with an mPAP/CO slope of >3 mmHg/L/min, (3) chronic thromboembolic pulmonary hypertension (CTEPH); those with mPAP >20 mmHg, pulmonary arterial wedge pressure (PAWP) ≤ 15 mmHg and pulmonary vascular resistance >2 WU. The postcapillary contribution during exercise was considered present if the PAWP/CO slope of >2 mmHg/L/min. CTEPD without resting pulmonary hypertension (PH) was present in 29 (81%) of the 36 patients, of whom six (21%) had ePH, while five (14%) had CTEPH. Two patients had unclassified PH. Two (33%) of the six patients with CTEPD‐ePH had a PAWP/CO slope of >2 mmHg/L/min, compared with two (40%) of the five of those with CTEPH. In conclusion, about 20% of patients with CTEPD and exertional dyspnoea had ePH. Exercise right heart catheterization revealed a notable proportion of patients with postcapillary contribution. |
| format | Article |
| id | doaj-art-daf509c3fa494069a35ddd0b8acfdd76 |
| institution | Kabale University |
| issn | 2045-8940 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pulmonary Circulation |
| spelling | doaj-art-daf509c3fa494069a35ddd0b8acfdd762024-12-27T05:54:34ZengWileyPulmonary Circulation2045-89402024-10-01144n/an/a10.1002/pul2.70018Exercise pulmonary hypertension in chronic thromboembolic pulmonary disease: A right heart catheterization studyAdam Dhayyat0Janne Mykland Hilde1Øyvind Jervan2Diyar Rashid3Jostein Gleditsch4Knut Stavem5Waleed Ghanima6Kjetil Steine7Department of Cardiology Østfold Hospital, Kalnes Gralum NorwayDepartment of Cardiology Akershus University Hospital Lorenskog NorwayDepartment of Cardiology Østfold Hospital, Kalnes Gralum NorwayDepartment of Radiology Østfold Hospital, Kalnes Gralum NorwayInstitute of Clinical Medicine University of Oslo Oslo NorwayInstitute of Clinical Medicine University of Oslo Oslo NorwayInstitute of Clinical Medicine University of Oslo Oslo NorwayInstitute of Clinical Medicine University of Oslo Oslo NorwayAbstract Many patients with chronic thromboembolic pulmonary disease (CTEPD) suffer from exertional dyspnea. It is unclear if CTEPD is associated with exercise pulmonary hypertension (ePH). This cross‐sectional study aimed to determine the occurrence of ePH in patients with CTEPD and to identify the haemodynamic changes during exercise. We recruited 36 patients with persistent dyspnoea and residual perfusion defects by ventilation/perfusion scintigraphy from a large cohort of patients with previous pulmonary embolism. All patients underwent exercise right heart catheterization before being classified into the following groups: (1) CTEPD without ePH; comprising patients with normal mean pulmonary artery pressure (mPAP) of ≤20 mmHg, but with mPAP/cardiac output (CO) slope of ≤3 mmHg/L/min, (2) CTEPD with ePH (CTEPD‐ePH); those with CTEPD with an mPAP/CO slope of >3 mmHg/L/min, (3) chronic thromboembolic pulmonary hypertension (CTEPH); those with mPAP >20 mmHg, pulmonary arterial wedge pressure (PAWP) ≤ 15 mmHg and pulmonary vascular resistance >2 WU. The postcapillary contribution during exercise was considered present if the PAWP/CO slope of >2 mmHg/L/min. CTEPD without resting pulmonary hypertension (PH) was present in 29 (81%) of the 36 patients, of whom six (21%) had ePH, while five (14%) had CTEPH. Two patients had unclassified PH. Two (33%) of the six patients with CTEPD‐ePH had a PAWP/CO slope of >2 mmHg/L/min, compared with two (40%) of the five of those with CTEPH. In conclusion, about 20% of patients with CTEPD and exertional dyspnoea had ePH. Exercise right heart catheterization revealed a notable proportion of patients with postcapillary contribution.https://doi.org/10.1002/pul2.70018exertional dyspnoeamPAP/CO slopepulmonary circulationpulmonary embolism |
| spellingShingle | Adam Dhayyat Janne Mykland Hilde Øyvind Jervan Diyar Rashid Jostein Gleditsch Knut Stavem Waleed Ghanima Kjetil Steine Exercise pulmonary hypertension in chronic thromboembolic pulmonary disease: A right heart catheterization study Pulmonary Circulation exertional dyspnoea mPAP/CO slope pulmonary circulation pulmonary embolism |
| title | Exercise pulmonary hypertension in chronic thromboembolic pulmonary disease: A right heart catheterization study |
| title_full | Exercise pulmonary hypertension in chronic thromboembolic pulmonary disease: A right heart catheterization study |
| title_fullStr | Exercise pulmonary hypertension in chronic thromboembolic pulmonary disease: A right heart catheterization study |
| title_full_unstemmed | Exercise pulmonary hypertension in chronic thromboembolic pulmonary disease: A right heart catheterization study |
| title_short | Exercise pulmonary hypertension in chronic thromboembolic pulmonary disease: A right heart catheterization study |
| title_sort | exercise pulmonary hypertension in chronic thromboembolic pulmonary disease a right heart catheterization study |
| topic | exertional dyspnoea mPAP/CO slope pulmonary circulation pulmonary embolism |
| url | https://doi.org/10.1002/pul2.70018 |
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