Persistent exercise limitation after successful pulmonary endoarterectomy: frequency and determinants.
Adult
Age Factors
Aged
Aged, 80 and over
Cohort Studies
Endarterectomy
Exercise
Exercise Test
Exercise Tolerance
Female
Humans
Male
Middle Aged
Postoperative Period
Pulmonary Artery
/ surgery
Pulmonary Disease, Chronic Obstructive
/ physiopathology
Respiratory Function Tests
Ventricular Dysfunction, Right
/ etiology
Walking
Young Adult
Embolism
Hypertension, pulmonary
Physical exertion
Surgical procedures
Journal
Respiratory research
ISSN: 1465-993X
Titre abrégé: Respir Res
Pays: England
ID NLM: 101090633
Informations de publication
Date de publication:
14 Feb 2019
14 Feb 2019
Historique:
received:
23
11
2018
accepted:
06
02
2019
entrez:
16
2
2019
pubmed:
16
2
2019
medline:
14
6
2019
Statut:
epublish
Résumé
After successful pulmonary endoarterectomy (PEA), patients may still suffer from exercise limitation, despite normal pulmonary vascular resistance. We sought to assess the proportion of these patients after the extension of PEA to frail patients, and the determinants of exercise limitation. Out of 553 patients treated with PEA from 2008 to 2016 at our institution, a cohort of 261 patients was followed up at 12 months. They underwent clinical, haemodynamic, echocardiographic, respiratory function tests and treadmill exercise testing. A reduced exercise capacity was defined as Bruce test distance < 400 m. Eighty patients did not had exercise testing because of inability to walk on treadmill and/or ECG abnormalities Exercise limitation 12 months after PEA was present in 74/181 patients (41, 95%CI 34 to 48%). The presence of COPD was more than double in patients with exercise limitation than in the others. Patients with persistent exercise limitation had significantly higher mPAP, PVR, HR and significantly lower RVEF, PCa, CI, VC, TLC, FEV After successful PEA, most of the patients recovered good exercise tolerance. However, about 40% continues to suffer from limitation to a moderate intensity exercise. Besides parameters of right ventricular function, useful information are provided by respiratory function parameters and COPD diagnosis. This could be useful to better address the appropriate therapeutic approach.
Sections du résumé
BACKGROUND
BACKGROUND
After successful pulmonary endoarterectomy (PEA), patients may still suffer from exercise limitation, despite normal pulmonary vascular resistance. We sought to assess the proportion of these patients after the extension of PEA to frail patients, and the determinants of exercise limitation.
METHODS
METHODS
Out of 553 patients treated with PEA from 2008 to 2016 at our institution, a cohort of 261 patients was followed up at 12 months. They underwent clinical, haemodynamic, echocardiographic, respiratory function tests and treadmill exercise testing. A reduced exercise capacity was defined as Bruce test distance < 400 m.
RESULTS
RESULTS
Eighty patients did not had exercise testing because of inability to walk on treadmill and/or ECG abnormalities Exercise limitation 12 months after PEA was present in 74/181 patients (41, 95%CI 34 to 48%). The presence of COPD was more than double in patients with exercise limitation than in the others. Patients with persistent exercise limitation had significantly higher mPAP, PVR, HR and significantly lower RVEF, PCa, CI, VC, TLC, FEV
CONCLUSIONS
CONCLUSIONS
After successful PEA, most of the patients recovered good exercise tolerance. However, about 40% continues to suffer from limitation to a moderate intensity exercise. Besides parameters of right ventricular function, useful information are provided by respiratory function parameters and COPD diagnosis. This could be useful to better address the appropriate therapeutic approach.
Identifiants
pubmed: 30764853
doi: 10.1186/s12931-019-1002-5
pii: 10.1186/s12931-019-1002-5
pmc: PMC6376724
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
34Références
Am J Respir Crit Care Med. 2003 Jan 15;167(2):211-77
pubmed: 12524257
Eur Respir J. 2005 Nov;26(5):948-68
pubmed: 16264058
Thorax. 2008 Dec;63(12):1040-5
pubmed: 18492741
Am J Respir Crit Care Med. 2008 Aug 15;178(4):419-24
pubmed: 18556630
Interact Cardiovasc Thorac Surg. 2009 Oct;9(4):626-9
pubmed: 19608561
Chest. 2011 Jan;139(1):122-7
pubmed: 20671059
J Thorac Cardiovasc Surg. 2012 Jul;144(1):100-7
pubmed: 22498087
Eur J Cardiothorac Surg. 2012 Jun;41(6):e154-60
pubmed: 22593260
Thorax. 2014 Feb;69(2):116-22
pubmed: 24052543
Eur Respir J. 2014 May;43(5):1403-9
pubmed: 24435007
Am J Cardiol. 2014 Jul 1;114(1):136-40
pubmed: 24819907
J Thorac Cardiovasc Surg. 2014 Sep;148(3):1005-11; 1012.e1-2; discussion 1011-2
pubmed: 25129589
J Am Heart Assoc. 2015 Mar 23;4(3):e001602
pubmed: 25801760
J Cardiovasc Med (Hagerstown). 2016 Feb;17(2):144-51
pubmed: 26702594
Eur Respir Rev. 2017 Mar 15;26(143):
pubmed: 28298388
Circulation. 1977 Nov;56(5):699-712
pubmed: 334392
J Appl Physiol. 1969 Jan;26(1):31-7
pubmed: 5762873
Eur J Appl Physiol Occup Physiol. 1976 Aug 12;35(3):191-200
pubmed: 954738