Zhao Zhi-hui, Liu Zhi-hong, Gu Qing, Luo Qin, Zhao Qing, Xiong Chang-ming, Ni Xin-hai
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.
Zhonghua Yi Xue Za Zhi. 2013 Jun 11;93(22):1687-90.
To evaluate the application value of cardiopulmonary exercise testing in patients with chronic thromboembolic pulmonary hypertension (CTEPH).
A total of 116 consecutive patients admitted into the Cardiology Department of Fuwai Hospital.They were divided into 3 groups of CTEPH (n = 44), CPE (without pulmonary hypertension in chronic pulmonary embolism) (n = 24) and control (without pulmonary embolism or pulmonary hypertension) (n = 48) respectively. Their levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured. Incremental cardiopulmonary exercise testing was performed to compare its differential results among 3 groups and evaluate the correlation between NT-proBNP and its parameters.
The body mass index (BMI) in the CTEPH group was lower than those in the CPE and control groups ((23.8 ± 3.9) vs (26.1 ± 3.6) and (26.7 ± 3.2) kg/m(2) ), both P < 0.05); the medical history in the CTEPH group was longer than those in the CPE and control groups ((58 ± 48) vs (12 ± 10) and (29 ± 25) months, both P < 0.05). The plasma concentrations of NT-proBNP in the CTEPH group were higher than those in the CPE and control groups ((1678 ± 1255) vs (577 ± 167) and (608 ± 247) pmol/L, both P < 0.05). All of them completed the test and there were no severe complications such as syncope or exacerbation of disease. Maximum oxygen consumption (VO2max), percentage of predicted maximum oxygen consumption (VO2 %), oxygen consumption in relation to body weight (VO2/kg), anaerobic threshold and O2 pulse in the CTEPH group were significantly lower than those in the CPE and control groups (P < 0.05). The ratios of dead space volume (VD) to tidal volume (VT) in the CTEPH and CPE groups were higher than those in the control group (P < 0.05). The plasma concentrations of NT-proBNP were inversely correlated with right ventricular internal diameter (r = -0.690, P = 0.000) and VO2/kg (r = -0.496, P = 0.000). The right ventricular internal diameter (β = 0.583, P = 0.000) and VO2/kg (β = 0.233, P = 0.032) were strong independent determinants of NT-proBNP.
As a reliable pathophysiological indictor of CTEPH, cardiopulmonary exercise testing may be used objectively and safely to evaluate the cardiopulmonary function of CTEPH patients.
评估心肺运动试验在慢性血栓栓塞性肺动脉高压（CTEPH）患者中的应用价值。
连续纳入阜外医院心内科116例患者。将其分别分为CTEPH组（n = 44）、慢性肺栓塞无肺动脉高压（CPE）组（n = 24）和对照组（无肺栓塞或肺动脉高压）（n = 48）。检测其N末端脑钠肽前体（NT-proBNP）水平。进行递增式心肺运动试验，比较三组间的差异结果，并评估NT-proBNP与其参数之间的相关性。
CTEPH组的体重指数（BMI）低于CPE组和对照组（（23.8 ± 3.9） vs （26.1 ± 3.6）和（26.7 ± 3.2）kg/m²，P均< 0.05）；CTEPH组的病史长于CPE组和对照组（（58 ± 48） vs （12 ± 10）和（29 ± 25）个月，P均< 0.05）。CTEPH组的血浆NT-proBNP浓度高于CPE组和对照组（（1678 ± 1255） vs （577 ± 167）和（608 ± 247）pmol/L，P均< 0.05）。所有患者均完成试验，未出现晕厥或病情加重等严重并发症。CTEPH组的最大摄氧量（VO2max）、预测最大摄氧量百分比（VO2 %）、每千克体重摄氧量（VO2/kg）、无氧阈和氧脉搏均显著低于CPE组和对照组（P < 0.05）。CTEPH组和CPE组的死腔容积（VD）与潮气量（VT）之比高于对照组（P < 0.05）。血浆NT-proBNP浓度与右心室内径（r = -0.690，P = 0.000）和VO2/kg（r = -0.496，P = 0.000）呈负相关。右心室内径（β = 0.583，P = 0.000）和VO2/kg（β = 0.233，P = 0.032）是NT-proBNP的强独立决定因素。
作为CTEPH可靠的病理生理指标，心肺运动试验可客观、安全地用于评估CTEPH患者的心肺功能。
