Oliveros Estefania, Mauri Madeline, Pietrowicz Rylie, Sadek Ahmed, Lakhter Vladimir, Bashir Riyaz, Auger William R, Vaidya Anjali, Forfia Paul R
Division of Cardiovascular Disease, Department of Medicine, Temple University Hospital, Philadelphia, PA 19140, USA.
Department of Medicine, University of California, San Diego, CA 92093, USA.
J Clin Med. 2024 Dec 17;13(24):7702. doi: 10.3390/jcm13247702.
: Invasive cardiopulmonary exercise testing (iCPET) provides valuable insight into dyspnea in patients with chronic thromboembolic pulmonary disease, in part through an increased relationship of minute ventilation to CO production (V/VCO). Obesity lowers the V/VCO in patients without cardiopulmonary disease; however, whether this holds true in obese subjects with chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary disease (CTEPD) is unknown. : Report on the iCPET findings of patients with CTEPH and CTEPD and investigate the relationship between obesity and gas exchange parameters, especially V/VCO in these patients. : Retrospective analysis of CTEPH and CTEPD patients undergoing iCPET. : We studied 60 patients; 34 (56.7%) had CTEPH and 26 (43.3%) had CTEPD. The mean age was 61.2 ± 14 years and the mean BMI was 31.8 ± 8.3 mg/kg. A higher V/VCO (41.9 ± 10.2 vs. 36.8 ± 8.9; = 0.045) was observed in CTEPH vs. CTEPD. There was an inverse relationship between the V/VCO slope and BMI. For an increase of 1 point in BMI, the V/VCO slope fell by 0.6 in CTEPD and 0.35 in CTEPH ( < 0.001). The mean V/VCO slope in CTEPH and CTEPD groups was 48.6 ± 10.4 in BMI < 25 and 31.3 ± 6.5 in BMI > 35 ( < 0.001). The lower V/VCO slope in obesity relates to an increased VCO/work rate relationship; there was no difference in the V/work relationship. : The V/VCO slope is markedly reduced by obesity, independent of the level of pulmonary vascular obstruction in CTEPH or CTEPD. Thus, obesity masks key physiologic evidence of pulmonary vascular obstruction on the gas exchange assessment of obese individuals.
侵入性心肺运动试验（iCPET）能为慢性血栓栓塞性肺疾病患者的呼吸困难提供有价值的见解，部分原因是分钟通气量与二氧化碳产生量的关系（V/VCO）增加。肥胖会降低无心肺疾病患者的V/VCO；然而，在患有慢性血栓栓塞性肺动脉高压（CTEPH）和慢性血栓栓塞性肺疾病（CTEPD）的肥胖受试者中是否也是如此尚不清楚。：报告CTEPH和CTEPD患者的iCPET结果，并研究肥胖与气体交换参数之间的关系，尤其是这些患者的V/VCO。：对接受iCPET的CTEPH和CTEPD患者进行回顾性分析。：我们研究了60例患者；34例（56.7%）患有CTEPH，26例（43.3%）患有CTEPD。平均年龄为61.2±14岁，平均体重指数为31.8±8.3mg/kg。与CTEPD相比，CTEPH患者的V/VCO更高（41.9±10.2对36.8±8.9；P = 0.045）。V/VCO斜率与体重指数呈负相关。体重指数每增加1个单位，CTEPD患者的V/VCO斜率下降0.6，CTEPH患者下降0.35（P<0.001）。体重指数<25的CTEPH和CTEPD组的平均V/VCO斜率为48.6±10.4，体重指数>35的为31.3±6.5（P<0.001）。肥胖时较低的V/VCO斜率与VCO/工作率关系增加有关；V/工作关系无差异。：肥胖显著降低了V/VCO斜率，与CTEPH或CTEPD中肺血管阻塞的程度无关。因此，肥胖掩盖了肥胖个体气体交换评估中肺血管阻塞的关键生理证据。
