|Response to symptom-limited exercise in patients with the hepatopulmonary syndrome.|
|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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|Type: Journal Article|
|Title: Chest Volume: 114 ISSN: 0012-3692 ISO Abbreviation: Chest Publication Date: 1998 Sep|
|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|
|Languages: eng Pagination: 736-41 Citation Subset: AIM; IM|
|APA/MLA Format Download EndNote Download BibTex|
Anoxia / physiopathology
Carbon Dioxide / blood
Liver Cirrhosis / physiopathology
Liver Diseases / physiopathology*
Lung Diseases / blood, physiopathology*
Lung Volume Measurements
Oxygen / blood
Pulmonary Gas Exchange
Ventricular Function, Left
|142M471B3J/Carbon Dioxide; S88TT14065/Oxygen|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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