Cardiopulmonary exercise testing in patients with precapillary pulmonary hypertension with an unfavorable prognosis

• Published in: Kardiovaskuli͡a︡rnai͡a︡ terapii͡a︡ i profilaktika Vol. 23; no. 9; p. 4088
• Main Authors: Berezina, A. V., Zlobina, I. S., Goncharova, N. S., Simakova, M. A., Lapshin, K. B., Moiseeva, O. M.
• Format: Journal Article
• Language: English
• Published: 23.10.2024
• ISSN: 1728-8800; 2619-0125
• DOI: 10.15829/1728-8800-2024-4088

Aim. To compare clinical and hemodynamic parameters with survival of incident patients with idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH) with a prognostically unfavorable pattern of cardiopulmonary exercise testing (CPET) parameters. Material and methods . The study included 48 incident cases with a verified diagnosis of IPAH (n=18) and CTEPH (n=30). All patients were examined in accordance with the European Society of Cardiology and the European Respiratory Society guidelines (2015). The inclusion criterion was the ventilatory equivalent for carbon dioxide (CO 2 ) according to the CPET (VE/VCO 2 ) >44, indicating an unfavorable prognosis for patients. Results. VE/VCO 2 in the examined patients with IPAH and CTEPH averaged 70,6±0,8 and did not differ in the study groups. Hemodynamic parameters of patients with IPAH and CTEPH also indicated a high risk of adverse events as follows: cardiac index — 1,9±0,1 and 1,8±0,1 l/min/m 2 , respectively (p=0,3). Peak oxygen consumption, anaerobic threshold level, oxygen delivery to work performed were reduced in both groups. However, patients with IPAH did not have a decrease in dead space ventilation and desaturation severity during exercise was greater than in patients with CTEPH. Patients with CTEPH had better survival compared to patients with IPAH: 1 year — 89 vs 83%, 3 years — 84 vs 65%, 5 years — 73 vs 35%, 7 years — 55 vs 36%. Conclusion. Among patients with IPAH and CTEPH who have an unfavorable prognosis, patients with IPAH demonstrate a more pronounced decrease in cardiovascular and respiratory reserves, which negatively affects patient survival. CPET may be a valuable non-invasive method for death risk stratification in patients with IPAH and CTEPH.