What is it about?
Borderline resting mean pulmonary arterial pressure (mPAP) is associated with adverse outcomes and affects the exercise pulmonary vascular response. However, the pathophysiological mechanisms underlying exertional intolerance in borderline mPAP remain incompletely characterized. In the current study, we evaluated the prevalence and functional implications of exercise pulmonary hypertension (ePH) across a spectrum of resting mean pulmonary arterial pressures (mPAP) currently considered to be normal, including borderline mPAP; and we contrasted ePH pathophysiological mechanisms underlying exercise intolerance to those of patients with resting precapillary pulmonary hypertension (rPH).
Featured Image
Why is it important?
We show that ePH prevalence increases as a function of higher resting mPAP values, being most frequently found in borderline mPAP. But most important, we demonstrate that ePH substantively affects exercise capacity regardless of the resting mPAP range and that the functional impact of ePH is similar to that of rPH. Our data suggest that patients with borderline mPAP benefit from the evaluation of the pulmonary circulation under the stress of exercise to uncover physiologically and clinically relevant early pulmonary vascular disease.
Perspectives
The current study is the largest to date of its kind and the first to explain the mechanisms of reduction of maximum exercise oxygen uptake in ePH, by simultaneously measuring its Fick Principle components and pulmonary hemodynamics. Assuming that pulmonary vascular dysfunction is a progressive phenomenon and that its late diagnosis is a major contributor to patient’s poor outcomes, considering ePH (rather than borderline resting mPAP) as an early stage of pulmonary vascular disease might be of major clinical relevance, potentially allowing early and more effective therapeutic interventions that could impact PH natural history.
Rudolf Oliveira
Federal University of Sao Paulo
Read the Original
This page is a summary of: Functional impact of exercise pulmonary hypertension in patients with borderline resting pulmonary arterial pressure, Pulmonary Circulation, June 2017, SAGE Publications,
DOI: 10.1177/2045893217709025.
You can read the full text:
Contributors
The following have contributed to this page
