Document Detail

Response to symptom-limited exercise in patients with the hepatopulmonary syndrome.
MedLine Citation:
PMID:  9743159     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To study the response to symptom-limited exercise in patients with the hepatopulmonary syndrome (HPS).
DESIGN: The response to maximal cardiopulmonary exercise (CPX) was studied in 5 patients with HPS and compared with 10 case control (normoxemic, NC) cirrhotics (matched for age, gender, etiology and severity of liver disease, tobacco use, and beta-blocker therapy) and 9 hypoxemic control cirrhotics (HC) without clinical evidence of HPS.
SETTING: Cardiopulmonary exercise physiology laboratory in a tertiary care referral center.
PATIENTS: Cirrhotics referred for CPX as part of their preliver transplantation evaluation.
MEASUREMENTS: Standard pulmonary function tests and echocardiography were performed to assess resting pulmonary and cardiac function. Peak oxygen consumption (VO2), minute ventilation, arterial blood gases, and dead space (VD/VT) were determined during symptom-limited maximal CPX.
RESULTS: Resting spirometry and lung volumes were similar between HPS and NC subjects, while HC subjects had restrictive physiology. Differences existed in diffusing capacity corrected for hemoglobin and alveolar volume percent predicted (HPS, 45+/-2 vs NC, 68+/-3, p<0.05; vs HC, 70+/-4, p<0.05), PaO2 (HPS, 70+/-5 mm Hg; HC, 79+/-3 mm Hg, vs NC, 102+/-3 mm Hg, p<0.05) and alveolar-arterial (A-a) O2 gradient (HPS, 42+/-8 mm Hg vs HC, 27+/-2 mm Hg, p<0.05; vs NC, 6+/-2 mm Hg, p<0.05). During CPX, HPS patients achieved a lower peak VO2 percent predicted (HPS, 55+/-6 vs NC, 73+/-3, p<0.05; vs HC, 71+/-5, p<0.05) and VO2 at the ventilatory threshold as percent predicted peak VO2 (HPS, 36+/-2 vs NC, 55+/-4, p<0.05; vs HC 55+/-5, p<0.05). While no differences existed in heart rate and breathing reserve, HPS patients had significantly lower PaO2 (HPS, 50+/-5 mm Hg vs NC, 97+/-4 mm Hg, p<0.05; vs HC, 87+/-6 mm Hg, p<0.05), wider A-a O2 gradient (HPS, 73+/-5 mm Hg vs NC, 13+/-3 mm Hg, p<0.05; vs HC, 31+/-5 mm Hg, p<0.05) and higher VD/VT (HPS, 0.36+/-.03 vs NC, 0.18+/-.02, p<0.05; vs HC, 0.28+/-.02, p<0.05) at peak exercise. For HPS patients, VO2 was negatively correlated with VD/VT (r2=0.9) and positively correlated with PaO2 (r2=0.41) at peak exercise.
CONCLUSIONS: Patients with HPS demonstrate a severe reduction in aerobic capacity, beyond that found in cirrhotics without syndrome. The significant hypoxemia and elevated VD/VT at peak exercise suggest that an abnormal pulmonary circulation contributes to further exercise limitation in patients with HPS.
S K Epstein; M D Zilberberg; C Jacoby; R L Ciubotaru; L M Kaplan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chest     Volume:  114     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1998 Sep 
Date Detail:
Created Date:  1998-10-01     Completed Date:  1998-10-01     Revised Date:  2014-07-29    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  736-41     Citation Subset:  AIM; IM    
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MeSH Terms
Anoxia / physiopathology
Carbon Dioxide / blood
Exercise Test*
Heart Rate
Liver Cirrhosis / physiopathology
Liver Diseases / physiopathology*
Lung Diseases / blood,  physiopathology*
Lung Volume Measurements
Middle Aged
Oxygen / blood
Pulmonary Gas Exchange
Respiratory Mechanics
Stroke Volume
Ventricular Function, Left
Reg. No./Substance:
142M471B3J/Carbon Dioxide; S88TT14065/Oxygen

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