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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/19010

Title: Exercise pathophysiology and sildenafil effects in chronic thromboembolic pulmonary hypertension
Authors: Claessen, Guido
La Gerche, Andre
Wielandts, Jean-Yves
Bogaert, Jan
Van Cleemput, Johan
Wuyts, Wim
Claus, Piet
Delcroix, Marion
Issue Date: 2015
Citation: HEART, 101 (8), p. 637-644
Abstract: Objectives Symptoms in patients with chronic thromboembolic pulmonary hypertension (CTEPH) predominantly occur during exercise, while haemodynamic assessment is generally performed at rest. We hypothesised that exercise imaging of RV function would better explain exercise limitation and the acute effects of pulmonary vasodilator administration than resting measurements. Methods Fourteen patients with CTEPH and seven healthy control subjects underwent cardiopulmonary testing to determine peak exercise oxygen consumption (VO(2)peak) and ventilatory equivalent for carbon dioxide (VE/VCO2) at the anaerobic threshold. Subsequently, cardiac MRI was performed at rest and during supine bicycle exercise with simultaneous invasive measurement of mean pulmonary arterial pressure (mPAP) before and after sildenafil. Results During exercise, patients with CTEPH had a greater increase in the ratio of mPAP relative to cardiac output (CO) than controls (6.7 (5.1-8.7) vs 0.94 (0.8-61.8) mm Hg/L/min; p<0.001). Stroke volume index (SVi) and RVEF increased during exercise in controls, but not in patients with CTEPH (interaction p<0.001). Sildenafil decreased the mPAP/CO slope and increased SVi and RVEF in patients with CTEPH (p<0.05) but not in controls. In patients with CTEPH, RVEF reserve correlated moderately with VO(2)peak (r=0.60; p=0.030) and VE/VCO2 (r=-0.67; p=0.012). By contrast, neither VO(2)peak nor VE/VCO2 correlated with resting RVEF. Conclusions Exercise measures of RV function explain much of the variance in the exercise capacity of patients with CTEPH while resting measures do not. Sildenafil increases SVi during exercise in patients with CTEPH, but not in healthy subjects.
Notes: [Claessen, Guido; La Gerche, Andre; Wielandts, Jean-Yves; Van Cleemput, Johan] Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium. [Claessen, Guido; Wielandts, Jean-Yves; Bogaert, Jan; Van Cleemput, Johan; Wuyts, Wim; Delcroix, Marion] Univ Hosp Leuven, Leuven, Belgium. [La Gerche, Andre] Univ Melbourne, St Vincents Hosp, Fitzroy, Vic 3065, Australia. [Bogaert, Jan] Univ Leuven, Dept Imaging & Pathol, Leuven, Belgium. [Wuyts, Wim; Claus, Piet; Delcroix, Marion] Univ Leuven, Dept Clin & Expt Med, Leuven, Belgium. [Heidbuchel, Hein] Univ Hasselt & Heart Ctr, Jessa Hosp, Hasselt, Belgium.
URI: http://hdl.handle.net/1942/19010
DOI: 10.1136/heartjnl-2014-306851
ISI #: 000351755300012
ISSN: 1355-6037
Category: A1
Type: Journal Contribution
Validation: ecoom, 2016
Appears in Collections: Research publications

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