Division of Cardiovascular Medicine, Department of Internal Medicine (Mr Tsuboi and Drs Tanaka, Nishio, Sawa, Terashita, Nakayama, Satomi-Kobayashi, Emoto, and Hirata), and Division of Rehabilitation (Mr Tsuboi and Dr Sakai), Kobe University Graduate School of Medicine, Japan.
J Cardiopulm Rehabil Prev. 2017 Sep;37(5):341-346. doi: 10.1097/HCR.0000000000000257.
Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are the main subgroups of pulmonary hypertension (PH). Despite differences in their etiologies, both diseases are characterized by vascular remodeling, resulting in progressive right heart failure. Noninvasive periodic evaluation of exercise tolerance has become increasingly important. Cardiopulmonary exercise testing (CPET) and a 6-minute walk test (6MWT) are now both recommended for evaluating exercise tolerance, but there is insufficient knowledge about possible differences in the associations of exercise tolerance with right heart catheterization (RHC) data for patients with PAH and CTEPH.
A retrospective study was performed with 57 patients with PH (24 with PAH and 33 with CTEPH) all of whom underwent echocardiography, CPET, 6MWT, and RHC.
For both patients with PAH and CTEPH, peak heart rate during CPET was significantly higher than that from 6MWT, whereas minimum peripheral oxygen saturation during CPET and 6MWT was similar. For patients with PAH, significant correlations were observed between peak (Equation is included in full-text article.)O2 and cardiac index (CI) (r = 0.59; P = .002) and between (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slopes and CI (r =-0.46, P = .02), as well as a nonsignificant correlation tendency for peak (Equation is included in full-text article.)O2 and pulmonary vascular resistance (PVR) and for (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 and PVR (r =-0.39; P = .05; and r = 0.39; P = .06, respectively). For patients with CTEPH, however, a significant correlation was observed only between (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slopes and CI (r =-0.38; P = .02).
PH etiology should be considered when assessing exercise tolerance, whereas CPET can be effective in addition to hemodynamic assessment by means of RHC for periodic evaluation during followup.
肺动脉高压（PAH）和慢性血栓栓塞性肺动脉高压（CTEPH）是肺动脉高压（PH）的主要亚组。尽管它们的病因不同，但这两种疾病都表现为血管重塑，导致右心衰竭进行性加重。非侵入性周期性评估运动耐量变得越来越重要。心肺运动测试（CPET）和 6 分钟步行测试（6MWT）现在都被推荐用于评估运动耐量，但对于 PAH 和 CTEPH 患者，运动耐量与右心导管检查（RHC）数据的相关性方面，我们的了解还不够充分。
回顾性研究了 57 例 PH 患者（24 例 PAH 和 33 例 CTEPH），所有患者均接受了超声心动图、CPET、6MWT 和 RHC 检查。
对于 PAH 和 CTEPH 患者，CPET 时的峰值心率均明显高于 6MWT，而 CPET 和 6MWT 时的最小外周血氧饱和度相似。对于 PAH 患者，峰值（Equation is included in full-text article.）O2 与心指数（CI）（r = 0.59；P =.002）以及（Equation is included in full-text article.）E/（Equation is included in full-text article.）CO2 斜率与 CI（r =-0.46，P =.02）之间存在显著相关性，而峰值（Equation is included in full-text article.）O2 与肺血管阻力（PVR）和（Equation is included in full-text article.）E/（Equation is included in full-text article.）CO2 与 PVR 之间存在显著相关性（r =-0.39；P =.05 和 r = 0.39；P =.06）。然而，对于 CTEPH 患者，仅观察到（Equation is included in full-text article.）E/（Equation is included in full-text article.）CO2 斜率与 CI 之间存在显著相关性（r =-0.38；P =.02）。
在评估运动耐量时应考虑 PH 的病因，而 CPET 除了通过 RHC 进行血流动力学评估外，还可以在随访期间进行周期性评估。
