Wallace William D, Nouraie Mehdi, Chan Stephen Y, Risbano Michael G
1 Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA.
2 Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Pulm Circ. 2018 Jul-Sep;8(3):2045894018787381. doi: 10.1177/2045894018787381. Epub 2018 Jun 19.
Exercise pulmonary hypertension (ePH) is an underappreciated form of exertional limitation. Despite normal resting pulmonary artery pressures, patients with ePH demonstrate early pulmonary vascular changes with reduced pulmonary arterial compliance (PAC) and vascular distensibility (α). Recent data suggest that targeted vasodilator therapy may improve hemodynamics in ePH, but it is not well-known whether such medications alter pulmonary vascular distensibility. Thus, we sought to evaluate if vasodilator therapy improved α a marker of early pulmonary vascular disease in ePH. Ten patients performed supine exercise right heart catheterization (exRHC) with bicycle ergometer to peak exercise. Patients diagnosed with ePH were treated with pulmonary vasodilators. A repeat symptom-limited exercise RHC was performed at least six months after therapy. Patients with ePH had evidence of early pulmonary vascular disease, as baseline PAC and α were reduced. After pulmonary vasodilator therapy, a number of peak exercise hemodynamics statistically improved, including a decrease of total pulmonary resistance and pulmonary vascular resistance, while cardiac output increased. Importantly, vasodilator therapy partially reversed the pathogenic decreases of α at the time of repeat exRHC. Pulmonary vascular distensibility, α, a marker of early pulmonary vascular disease, improves in ePH after therapy with pulmonary vasodilators.
运动性肺动脉高压（ePH）是一种未得到充分认识的运动受限形式。尽管静息肺动脉压正常，但ePH患者表现出早期肺血管变化，肺动脉顺应性（PAC）和血管扩张性（α）降低。最近的数据表明，靶向血管扩张剂治疗可能改善ePH患者的血流动力学，但此类药物是否会改变肺血管扩张性尚不清楚。因此，我们试图评估血管扩张剂治疗是否能改善α，α是ePH早期肺血管疾病的一个标志物。10例患者通过自行车测力计进行仰卧位运动右心导管检查（exRHC）至运动峰值。诊断为ePH的患者接受肺血管扩张剂治疗。治疗后至少6个月进行重复的症状限制性运动RHC。ePH患者有早期肺血管疾病的证据，因为基线PAC和α降低。肺血管扩张剂治疗后，一些运动峰值血流动力学指标在统计学上有所改善，包括总肺阻力和肺血管阻力降低，而心输出量增加。重要的是，在重复exRHC时，血管扩张剂治疗部分逆转了α的病理性降低。肺血管扩张性α是早期肺血管疾病的一个标志物，在接受肺血管扩张剂治疗后，ePH患者的α有所改善。
