Gonzalez-Garcia Mauricio, Conde-Camacho Rafael, Díaz Katherine, Rodríguez-Cortes Camilo, Rincon-Alvarez Emily
Fundación Neumológica Colombiana, 110131 Bogotá, Colombia.
Faculty of Medicine, Universidad de la Sabana, 250001 Chía, Colombia.
Rev Cardiovasc Med. 2024 Jul 4;25(7):247. doi: 10.31083/j.rcm2507247. eCollection 2024 Jul.
Cardiopulmonary exercise testing (CPET) assesses exercise capacity and causes of exercise limitation in patients with pulmonary hypertension (PH). At altitude, changes occur in the ventilatory pattern and a decrease in arterial oxygen pressure in healthy; these changes are increased in patients with cardiopulmonary disease. Our objective was to compare the response to exercise and gas exchange between patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) residing at the altitude of Bogotá (2640 m).
All patients performed an incremental CPET with measurement of oxygen consumption ( ), dead space (VD/VT), ventilatory equivalents (VE/ ), and alveolar-arterial oxygen gradient ( ). test and one-way analysis of variance were used for comparisons between PAH and CTEPH.
We included 53 patients, 29 with PAH, 24 with CTEPH, and 102 controls as a reference of the normal response to exercise at altitude. CTEPH patients had a higher New York Health Association (NYHA) functional class than PAH ( = 0.037). There were no differences between patients with PAH and CTEPH in hemodynamics and % of predicted (67.8 18.7 vs. 66.0 19.8, 0.05), but those with CTEPH had higher dyspnea, VD/VT (0.36 0.09 vs. 0.23 0.9, 0.001), VE/ (45.8 7.1 vs. 39.3 5.6, 0.001), and (19.9 7.6 vs. 13.5 7.6, 0.001) than PAH patients.
At altitude, patients with PH present severe alterations in gas exchange during exercise. There were no differences in exercise capacity between PAH and CTEPH, but patients with CTEPH had more dyspnea and greater alterations in gas exchange during exercise. CPET made it possible to identify alterations related to the pathophysiology of CTEPH that could explain the functional class and dyspnea in these patients.
心肺运动试验（CPET）可评估肺动脉高压（PH）患者的运动能力及运动受限原因。在高原地区，健康人的通气模式会发生改变，动脉血氧分压会降低；而心肺疾病患者的这些变化更为明显。我们的目的是比较居住在波哥大（海拔2640米）的肺动脉高压（PAH）患者和慢性血栓栓塞性肺动脉高压（CTEPH）患者对运动的反应及气体交换情况。
所有患者均进行递增式CPET，测量耗氧量（ ）、死腔（VD/VT）、通气当量（VE/ ）和肺泡-动脉血氧梯度（ ）。采用 检验和单因素方差分析对PAH和CTEPH进行比较。
我们纳入了53例患者，其中29例为PAH患者，24例为CTEPH患者，102例对照者作为高原地区运动正常反应的参考。CTEPH患者的纽约心脏协会（NYHA）功能分级高于PAH患者（ = 0.037）。PAH患者和CTEPH患者在血流动力学和预测值的 %方面无差异（67.8 ± 18.7 vs. 66.0 ± 19.8， ＞0.05），但CTEPH患者比PAH患者有更严重的呼吸困难、更高的VD/VT（0.36 ± 0.09 vs. 0.23 ± 0.9， ＜0.001）、更高的VE/ （45.8 ± 7.1 vs. 39.3 ± 5.6， ＜0.001）和 （19.9 ± 7.6 vs. 13.5 ± 7.6， ＜0.001）。
在高原地区，PH患者运动时气体交换存在严重改变。PAH和CTEPH患者的运动能力无差异，但CTEPH患者运动时呼吸困难更严重，气体交换改变更大。CPET能够识别与CTEPH病理生理学相关的改变，这些改变可以解释这些患者的功能分级和呼吸困难情况。
