Functional impact of exercise pulmonary hypertension in patients with borderline resting pulmonary arterial pressure

Detalhes bibliográficos
Autor(a) principal: Oliveira, Rudolf K. F. [UNIFESP]
Data de Publicação: 2017
Outros Autores: Faria-Urbina, Mariana, Maron, Bradley A., Santos, Mario, Waxman, Aaron B., Systrom, David M.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: http://dx.doi.org/10.1177/2045893217709025
https://repositorio.unifesp.br/handle/11600/53515
Resumo: Borderline resting mean pulmonary arterial pressure (mPAP) is associated with adverse outcomes and affects the exercise pulmonary vascular response. However, the pathophysiological mechanisms underlying exertional intolerance in borderline mPAP remain incompletely characterized. In the current study, we sought to evaluate the prevalence and functional impact of exercise pulmonary hypertension (ePH) across a spectrum of resting mPAP's in consecutive patients with contemporary resting right heart catheterization (RHC) and invasive cardiopulmonary exercise testing. Patients with resting mPAP < 25mmHg and pulmonary arterial wedge pressure <= 15mmHg (n=312) were stratified by mPAP < 13, 13-16, 17-20, and 21-24mmHg. Those with ePH (n=35) were compared with resting precapillary pulmonary hypertension (rPH
id UFSP_88ad4aec2a6c8c0acdc2aacd3aef0c76
oai_identifier_str oai:repositorio.unifesp.br/:11600/53515
network_acronym_str UFSP
network_name_str Repositório Institucional da UNIFESP
repository_id_str 3465
spelling Functional impact of exercise pulmonary hypertension in patients with borderline resting pulmonary arterial pressurepulmonary hypertensionexerciseoxygen uptakeoxygen deliverypathophysiologyBorderline resting mean pulmonary arterial pressure (mPAP) is associated with adverse outcomes and affects the exercise pulmonary vascular response. However, the pathophysiological mechanisms underlying exertional intolerance in borderline mPAP remain incompletely characterized. In the current study, we sought to evaluate the prevalence and functional impact of exercise pulmonary hypertension (ePH) across a spectrum of resting mPAP's in consecutive patients with contemporary resting right heart catheterization (RHC) and invasive cardiopulmonary exercise testing. Patients with resting mPAP < 25mmHg and pulmonary arterial wedge pressure <= 15mmHg (n=312) were stratified by mPAP < 13, 13-16, 17-20, and 21-24mmHg. Those with ePH (n=35) were compared with resting precapillary pulmonary hypertension (rPHn=16) and to those with normal hemodynamics (non-PHn=224). ePH prevalence was 6%, 8%, and 27% for resting mPAP 13-16, 17-20, and 21-24mmHg, respectively. Within each of these resting mPAP epochs, ePH negatively impacted exercise capacity compared with non-PH (peak oxygen uptake 70 +/- 16% versus 92 +/- 19% predicted, P < 0.0172 +/- 13% versus 86 +/- 17% predicted, P < 0.05and 64 +/- 15% versus 82 +/- 19% predicted, P < 0.001, respectively). Overall, ePH and rPH had similar functional limitation (peak oxygen uptake 67 +/- 15% versus 68 +/- 17% predicted, P > 0.05) and similar underlying mechanisms of exercise intolerance compared with non-PH (peak oxygen delivery 1868 +/- 599mL/min versus 1756 +/- 720mL/min versus 2482 +/- 875mL/min, respectivelyP < 0.05), associated with chronotropic incompetence, increased right ventricular afterload and signs of right ventricular/pulmonary vascular uncoupling. In conclusion, ePH is most frequently found in borderline mPAP, reducing exercise capacity in a manner similar to rPH. When borderline mPAP is identified at RHC, evaluation of the pulmonary circulation under the stress of exercise is warranted.Brigham & Womens Hosp, Dept Med, Div Pulm & Crit Care Med, 75 Francis St, Boston, MA 02115 USAHarvard Med Sch, Boston, MA USASystrom, David M.] Brigham & Womens Hosp, Heart & Vasc Ctr, 75 Francis St, Boston, MA 02115 USAFed Univ Sao Paulo UNIFESP, Dept Med, Div Resp Dis, Sao Paulo, SP, BrazilBrigham & Womens Hosp, Dept Med, Div Cardiovasc Med, 75 Francis St, Boston, MA 02115 USAVet Affairs Boston Healthcare Syst, Boston, MA USAUniv Porto, Fac Med, Dept Physiol & Cardiothorac Surg, Cardiovasc R&D Unit, Oporto, PortugalUniv Fed Sao Paulo UNIFESP, Dept Med, Div Resp Dis, Sao Paulo, SP, BrazilWeb of ScienceSage Publications Inc2020-06-26T16:30:23Z2020-06-26T16:30:23Z2017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion654-665application/pdfhttp://dx.doi.org/10.1177/2045893217709025Pulmonary Circulation. Thousand Oaks, v. 7, n. 3, p. 654-665, 2017.10.1177/2045893217709025WOS000411119000012.pdf2045-8932https://repositorio.unifesp.br/handle/11600/53515WOS:000411119000012engPulmonary CirculationThousand Oaksinfo:eu-repo/semantics/openAccessOliveira, Rudolf K. F. [UNIFESP]Faria-Urbina, MarianaMaron, Bradley A.Santos, MarioWaxman, Aaron B.Systrom, David M.reponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-11T01:05:35Zoai:repositorio.unifesp.br/:11600/53515Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-08-11T01:05:35Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Functional impact of exercise pulmonary hypertension in patients with borderline resting pulmonary arterial pressure
title Functional impact of exercise pulmonary hypertension in patients with borderline resting pulmonary arterial pressure
spellingShingle Functional impact of exercise pulmonary hypertension in patients with borderline resting pulmonary arterial pressure
Oliveira, Rudolf K. F. [UNIFESP]
pulmonary hypertension
exercise
oxygen uptake
oxygen delivery
pathophysiology
title_short Functional impact of exercise pulmonary hypertension in patients with borderline resting pulmonary arterial pressure
title_full Functional impact of exercise pulmonary hypertension in patients with borderline resting pulmonary arterial pressure
title_fullStr Functional impact of exercise pulmonary hypertension in patients with borderline resting pulmonary arterial pressure
title_full_unstemmed Functional impact of exercise pulmonary hypertension in patients with borderline resting pulmonary arterial pressure
title_sort Functional impact of exercise pulmonary hypertension in patients with borderline resting pulmonary arterial pressure
author Oliveira, Rudolf K. F. [UNIFESP]
author_facet Oliveira, Rudolf K. F. [UNIFESP]
Faria-Urbina, Mariana
Maron, Bradley A.
Santos, Mario
Waxman, Aaron B.
Systrom, David M.
author_role author
author2 Faria-Urbina, Mariana
Maron, Bradley A.
Santos, Mario
Waxman, Aaron B.
Systrom, David M.
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Oliveira, Rudolf K. F. [UNIFESP]
Faria-Urbina, Mariana
Maron, Bradley A.
Santos, Mario
Waxman, Aaron B.
Systrom, David M.
dc.subject.por.fl_str_mv pulmonary hypertension
exercise
oxygen uptake
oxygen delivery
pathophysiology
topic pulmonary hypertension
exercise
oxygen uptake
oxygen delivery
pathophysiology
description Borderline resting mean pulmonary arterial pressure (mPAP) is associated with adverse outcomes and affects the exercise pulmonary vascular response. However, the pathophysiological mechanisms underlying exertional intolerance in borderline mPAP remain incompletely characterized. In the current study, we sought to evaluate the prevalence and functional impact of exercise pulmonary hypertension (ePH) across a spectrum of resting mPAP's in consecutive patients with contemporary resting right heart catheterization (RHC) and invasive cardiopulmonary exercise testing. Patients with resting mPAP < 25mmHg and pulmonary arterial wedge pressure <= 15mmHg (n=312) were stratified by mPAP < 13, 13-16, 17-20, and 21-24mmHg. Those with ePH (n=35) were compared with resting precapillary pulmonary hypertension (rPH
publishDate 2017
dc.date.none.fl_str_mv 2017
2020-06-26T16:30:23Z
2020-06-26T16:30:23Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1177/2045893217709025
Pulmonary Circulation. Thousand Oaks, v. 7, n. 3, p. 654-665, 2017.
10.1177/2045893217709025
WOS000411119000012.pdf
2045-8932
https://repositorio.unifesp.br/handle/11600/53515
WOS:000411119000012
url http://dx.doi.org/10.1177/2045893217709025
https://repositorio.unifesp.br/handle/11600/53515
identifier_str_mv Pulmonary Circulation. Thousand Oaks, v. 7, n. 3, p. 654-665, 2017.
10.1177/2045893217709025
WOS000411119000012.pdf
2045-8932
WOS:000411119000012
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Pulmonary Circulation
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 654-665
application/pdf
dc.coverage.none.fl_str_mv Thousand Oaks
dc.publisher.none.fl_str_mv Sage Publications Inc
publisher.none.fl_str_mv Sage Publications Inc
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
instacron:UNIFESP
instname_str Universidade Federal de São Paulo (UNIFESP)
instacron_str UNIFESP
institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
_version_ 1814268337810571264

Registros relacionados