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Exercise testing in the clinical management of patients affected by pulmonary arterial hypertension.
MedLine Citation:
PMID:  23126000     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
Patients affected by pulmonary arterial hypertension (PAH) show a reduced exercise tolerance with early occurrence of dyspnoea and fatigue. The origin of functional capacity limitation is multifactorial and several mechanisms have been proposed, including right heart failure, which leads to a limited increase in cardiac output during exercise, and hyperventilation with a reduced perfusion of properly ventilated alveoli. In addition, abnormalities in arterial blood gases are observed, with the occurrence of hypoxemia and hypocapnia, related to an abnormal ventilation/perfusion match, gas diffusion abnormalities, low mixed venous oxygen saturation and to the development of intra- and extra-pulmonary right-to-left shunts. At present, the 6-minute walking test is the most used method to assess exercise tolerance in PAH; it is also useful to monitor the response to therapy and provides prognostic information. However, the assessment of functional capacity by cardiopulmonary exercise test (CPET) seems to be more complete, because CPET allows for discrimination between the metabolic, cardiovascular and pulmonary components of exercise limitation. Moreover, CPET estimates the severity of disease and assesses patients' prognosis and response to therapy. In PAH, a typical CPET-response is observed, characterized by a severe reduction in peak VO2, work rate, O2 pulse and anaerobic threshold and by a marked increase in VE/VCO2 slope and in the dead space to tidal volume ratio. However, the use of CPET should be limited to experienced centres. This review will focus on resting lung function and exercise tolerance tests, showing that CPET can provide the physiological explanation of functional limitation in PAH.
Authors:
Stefania Paolillo; Stefania Farina; Maurizio Bussotti; Annamaria Iorio; Pasquale PerroneFilardi; Massimo F Piepolil; Piergiuseppe Agostoni
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of preventive cardiology     Volume:  19     ISSN:  2047-4881     ISO Abbreviation:  Eur J Prev Cardiol     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-11-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101564430     Medline TA:  Eur J Prev Cardiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  960-71     Citation Subset:  IM    
Affiliation:
Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy.
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