Document Detail

Diagnosis of pulmonary vascular limit to exercise by cardiopulmonary exercise testing.
MedLine Citation:
PMID:  14734132     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Given the recent development of newer and less-invasive treatments for pulmonary hypertension, and the long wait for lung transplantation, early and correct diagnosis of this condition is increasingly important. The purpose of this study was to determine and improve the accuracy of a non-invasive, cardiopulmonary exercise-testing algorithm for detecting a pulmonary vascular limit to exercise. METHODS: We performed 130 consecutive, incremental cycling-exercise tests for exertional symptoms with pulmonary and radial artery catheters in place. Pulmonary vascular limit was defined as pulmonary vascular resistance at maximum exercise >120 dynes. sec/cm(5) and a peak-exercise systemic oxygen delivery <80% predicted, without a pulmonary mechanical limit or poor effort. We applied a previously reported non-invasive exercise-test-interpretation algorithm to each patient and sequentially manipulated branch point threshold values to maximize accuracy. RESULTS: The sensitivity of the original non-invasive algorithm for pulmonary vascular limit was 79%, specificity was 75%, and accuracy was 76%. Sensitivity did not change with systematic alteration of branch-point threshold values, but specificity and accuracy improved to 88% and 85%, respectively. Accuracy improved most by modifying the threshold values for percent predicted maximum oxygen uptake and carbon dioxide output ventilatory equivalents at lactate threshold. CONCLUSION: Non-invasive cardiopulmonary exercise testing is a useful tool for detecting and excluding a pulmonary vascular limit and for determining whether abnormal pulmonary hemodynamics limit aerobic capacity.
Deborah H Markowitz; David M Systrom
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  23     ISSN:  1053-2498     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2004-01-21     Completed Date:  2004-05-06     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  88-95     Citation Subset:  IM    
Pulmonary and Critical Care Unit, Medical Services Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 01655, USA.
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MeSH Terms
Anaerobic Threshold / physiology*
Exercise Test*
Hypertension, Pulmonary / diagnosis*
Middle Aged
Pulmonary Gas Exchange / physiology
Pulmonary Ventilation / physiology
Grant Support
1K24 HL04022-01/HL/NHLBI NIH HHS

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