Keusch Stephan, Bucher Anina, Müller-Mottet Séverine, Hasler Elisabeth, Maggiorini Marco, Speich Rudolf, Ulrich Silvia
Clinic of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland.
Clinic for Internal Medicine, University Hospital of Zurich, Zurich, Switzerland.
Multidiscip Respir Med. 2014 Oct 15;9(1):51. doi: 10.1186/2049-6958-9-51. eCollection 2014.
Data on exercise pulmonary hemodynamics in healthy people and patients with pulmonary hypertension (PH) are rare. We analyzed exercise right heart catheterization (RHC) data in a symptomatic collective referred with suspected PH to characterize the differential response by diagnostic groups, to correlate resting with exercise hemodynamics, and to evaluate safety.
This is a retrospective single-center study reviewing data from patients in whom an exercise RHC was performed between January 2006 and January 2013. Patients with follow-up RHC under PH -therapy were excluded.
Data from 101 patients were analyzed, none of them had an adverse event. In 35% we detected a resting PH (27.8% precapillary, 6.9% postcapillary). Exercise PH (mean pulmonary arterial pressure (mPAP) >30 mmHg at exercise) was found in 38.6%, whereas in 25.7% PH was excluded. We found a remarkable number of exercise PH in scleroderma patients, the majority being postcapillary. 83% of patients with mPAP-values between 20 and 24.9 mmHg at rest had exercise PH. Patients with resting PH had worse hemodynamics and were older compared with exercise PH ones.
In this real-life experience in symptomatic patients undergoing exercise RHC for suspected PH, we found that exercise RHC is safe. The facts that the vast majority of patients with mPAP-values between 20 and 24.9 mmHg at rest had exercise PH and the older age of patients with resting PH may indicate that exercise PH is a precursor of resting PH. Whether earlier treatment start in patients with exercise PH would stabilize the disease should be addressed in future studies.
关于健康人和肺动脉高压（PH）患者运动时肺血流动力学的数据很少。我们分析了因疑似PH而转诊的有症状人群的运动右心导管检查（RHC）数据，以描述不同诊断组的差异反应，将静息血流动力学与运动血流动力学相关联，并评估安全性。
这是一项回顾性单中心研究，回顾了2006年1月至2013年1月期间进行运动RHC的患者数据。排除接受PH治疗且有随访RHC的患者。
分析了101例患者的数据，无一例发生不良事件。35%的患者检测到静息PH（毛细血管前性27.8%，毛细血管后性6.9%）。运动性PH（运动时平均肺动脉压（mPAP）>30 mmHg）在38.6%的患者中被发现，而25.7%的患者排除了PH。我们发现硬皮病患者中有相当数量的运动性PH，大多数为毛细血管后性。静息时mPAP值在20至24.9 mmHg之间的患者中，83%有运动性PH。与运动性PH患者相比，静息PH患者的血流动力学更差且年龄更大。
在这项针对疑似PH进行运动RHC的有症状患者的实际研究中，我们发现运动RHC是安全的。静息时mPAP值在20至24.9 mmHg之间的绝大多数患者有运动性PH以及静息PH患者年龄较大这一事实可能表明运动性PH是静息PH的先兆。运动性PH患者更早开始治疗是否能使疾病稳定，应在未来研究中探讨。
