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Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise
Published on: February 20, 2017
Pulmonary haemodynamics during recovery from maximum incremental cycling exercise
Rudolf K F Oliveira1, Aaron B Waxman2, Manyoo Agarwal2
1Pulmonary and Critical Care Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA, USA Division of Respiratory Diseases, Dept of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Pulmonary haemodynamics during exercise recovery are not reliable for diagnosing exercise pulmonary hypertension (ePH) or venous hypertension (ePVH). Recovery measurements showed low sensitivity, though ePH and ePVH had distinct recovery patterns.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Exercise Physiology
Background:
- Assessing cardiac function during exercise is challenging.
- The recovery period offers a potential diagnostic window.
- Validity of exercise pulmonary haemodynamics during recovery is unproven.
Purpose of the Study:
- To evaluate directly measured pulmonary haemodynamics during 2-minute recovery.
- To assess diagnostic utility for exercise pulmonary hypertension (ePH) and exercise pulmonary venous hypertension (ePVH).
Main Methods:
- Invasive cardiopulmonary exercise testing in patients with unexplained exertional intolerance.
- Analysis of patients with ePH (n=36), ePVH (n=28), and controls (n=31).
- Measurement of pulmonary haemodynamics during 2-minute recovery.
Main Results:
- Mean pulmonary artery pressure (mPAP) and pulmonary arterial wedge pressure (PAWP) rapidly decreased post-exercise.
- Sensitivity for diagnosing ePH and ePVH using recovery haemodynamics was low (≤25%).
- Distinct recovery patterns in pulmonary vascular resistance (PVR) and compliance (PVC) were observed between ePH and ePVH.
Conclusions:
- Rapid decay of mPAP and PAWP during recovery compromises diagnostic sensitivity for pulmonary hypertension.
- Different PVR and PVC recovery patterns suggest distinct pathophysiologies in ePH and ePVH.
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