Document Detail


Doppler echocardiography and ultrafast cine computed tomography during dynamic exercise in chronic parenchymal pulmonary disease.
MedLine Citation:
PMID:  2773797     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In an effort to better understand the cardiac contribution to exercise limitation in chronic lung disease, 21 patients with advanced chronic pulmonary parenchymal disease and 10 normal control subjects were evaluated for changes in right ventricular (RV) pressure, volume and function during incremental, symptom-limited supine bicycle exercise. Patients underwent sequential exercise tests with Doppler echocardiography and ultrafast cine computed tomography (CT). RV systolic pressure during exercise was determined by saline-enhanced Doppler of tricuspid regurgitation. RV ejection fraction, end-diastolic volume, stroke volume and cardiac index were obtained by CT at rest and peak exercise. Sixteen of the 21 study patients also exercised on high-flow oxygen. In the control subjects RV systolic pressure increased from 21 +/- 6 mm Hg (mean +/- standard deviation) at rest to 32 +/- 8 mm Hg at peak exercise, whereas in patients with lung disease, RV systolic pressure increased from 42 +/- 17 to 81 +/- 26 mm Hg (both p less than 0.01). Compared with the control subjects, the patients with lung disease had significantly lower mean values for RV ejection fraction at rest (47 +/- 7 vs 55 +/- 7%) and at peak exercise (47 +/- 9 vs 57 +/- 3%, respectively, both p less than 0.05). The patients who demonstrated oxyhemoglobin desaturation during exercise showed the most abnormal cardiac responses, with marked increases in mean RV systolic pressure, decreases in mean RV ejection fraction and blunted increases in cardiac index and RV stroke volume. Although acute oxygen supplementation was associated with a slight decrease in RV systolic pressure at peak exercise and a longer duration of exercise, there was no significant improvement in RV function. Doppler echocardiography and CT provide complementary and potentially useful information about right-sided heart pressures and RV ejection fraction during exercise in patients with advanced chronic lung disease. Oxyhemoglobin desaturation during exercise is a marker for the most abnormal pulmonary vascular reserve, as indicated by RV contractile dysfunction and limited ability to increase cardiac index.
Authors:
R B Himelman; J A Abbott; E Lee; N B Schiller; N C Dean; M S Stulbarg
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The American journal of cardiology     Volume:  64     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1989 Sep 
Date Detail:
Created Date:  1989-10-05     Completed Date:  1989-10-05     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  528-33     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, University of California, San Francisco 94143.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Chronic Disease
Echocardiography, Doppler*
Exercise*
Humans
Lung Diseases / diagnosis*,  radiography
Lung Diseases, Obstructive / diagnosis,  radiography
Middle Aged
Oxygen / pharmacology
Oxyhemoglobins / analysis
Pulmonary Fibrosis / diagnosis,  radiography
Tomography, X-Ray Computed*
Grant Support
ID/Acronym/Agency:
HL07192/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Oxyhemoglobins; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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