Document Detail


Use of non-invasive haemodynamic measurements to detect treatment response in precapillary pulmonary hypertension.
MedLine Citation:
PMID:  21700759     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Haemodynamic measurements may be superior to the 6-min walk distance (6MWD) as outcome measures in pulmonary hypertension (PH) as they are directly linked to the mechanisms of disease and are not subject to a ceiling effect. The aim of this study was to determine if treatment response in precapillary PH could be detected by pulmonary blood flow (PBF) and stroke volume (SV) measured non-invasively by the inert gas rebreathing (IGR) method at rest and during submaximal constant-load cycle exercise.
METHODS: Twenty-four patients with precapillary PH receiving de novo or modified disease-targeted therapy were studied. Isotime metabolic variables, PBF and SV were measured at rest and during constant-load cycle exercise at 40% maximal work rate alongside conventional outcome variables, at baseline and after 3 months of new therapy.
RESULTS: At follow-up there was a significant increase in PBF (supine rest: mean 0.7±SD 0.9 l/min, erect rest: 0.7±0.8 l/min, exercise: 0.8±1.0 l/min, p<0.005) and SV (supine rest: 7±10 ml, erect rest: 10±11 ml, exercise: median 6 (IQR 3-11) ml, p<0.005). There was a trend for 6MWD to increase by 17±42 or 29 (13-47) m (p=0.061), whereas WHO functional class, N-terminal pro-brain natriuretic peptide or Cambridge Pulmonary Hypertension Outcome Review score were unchanged. In patients with higher baseline 6MWD, IGR measurements were more sensitive than 6MWD in detecting treatment response.
CONCLUSIONS: Non-invasive IGR haemodynamic measurements could be used to detect treatment response in patients with precapillary PH and may be more responsive to change than 6MWD in fitter patients.
Authors:
Wai-Ting Nicola Lee; Aileen Brown; Andrew John Peacock; Martin Keith Johnson
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-06-23
Journal Detail:
Title:  Thorax     Volume:  66     ISSN:  1468-3296     ISO Abbreviation:  Thorax     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-08-18     Completed Date:  2011-11-02     Revised Date:  2012-01-24    
Medline Journal Info:
Nlm Unique ID:  0417353     Medline TA:  Thorax     Country:  England    
Other Details:
Languages:  eng     Pagination:  810-4     Citation Subset:  IM    
Affiliation:
Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow G81 4DY, UK.
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MeSH Terms
Descriptor/Qualifier:
Breath Tests / methods*
Exercise Test / methods*
Exercise Tolerance / physiology
Female
Follow-Up Studies
Hemodynamics / physiology*
Humans
Hypertension, Pulmonary / diagnosis,  physiopathology*,  therapy
Male
Middle Aged
Prognosis
Reproducibility of Results
Retrospective Studies
Severity of Illness Index
Comments/Corrections
Comment In:
Thorax. 2012 Jan;67(1):81; author reply 81-2   [PMID:  21940492 ]

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


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