The lowest VE/VCO2 ratio best identifies chronic thromboembolic pulmonary hypertension |
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Authors: | Qunying Xi Zhihui Zhao Zhihong Liu Xiuping Ma Qin Luo Weihua Liu |
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Affiliation: | 1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China;2. Center for Pulmonary Vascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College |
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Abstract: | IntroductionThe natural history of acute pulmonary embolism (PE) under treatment is about a gradual resolution of the thrombi, and uncommonly, the development of chronic thromboembolic pulmonary hypertension (CTEPH). We hypothesized that ventilatory efficiency parameters during cardiopulmonary exercise testing (CPET) may be able to monitor the process and predict CTEPH.Methods15 patients rehabilitated from acute PE (total resolution of thrombi), 44 patients with chronic PE (with residual thrombi), 66 patients with CTEPH, and 36 sedentary healthy controls performed incremental CPET.ResultsThe lowest VE/VCO2 was higher in CTEPH patients than that in chronic PE and rehabilitated patients (43.4 L/min vs 29.9 L/min vs 27.1 L/min, p < 0.005). The VE/VCO2 slope (48.4 L/min/L/min vs 29.9 L/min/L/min vs 28.0 L/min/L/min, p < 0.005) and oxygen uptake efficiency plateau (OUEP) (37.1 L/min vs 27.0 L/min vs 25.2 L/min, p < 0.005) had the similar changes. In logistic regression analysis, the lowest VE/VCO2 ≥ 34.35 L/min was the best predictor of CTEPH (OR 159.0, 95% CI 36.0-702.3, p < 0.001). The lowest VE/VCO2 was higher in chronic PE patients compared with the controls (29.9 L/min vs 26.5 L/min, p < 0.05), but there was no difference between the rehabilitated patients and the controls. In multiple linear regression analysis, the percentage of vascular obstruction by ventilation-perfusion lung scanning (PVO) was the most significant independent predictor for indices of ventilatory efficiency in chronic PE and rehabilitated patients.ConclusionsCTEPH is associated with weakened ventilatory efficiency. The lowest VE/VCO2 ratio has the best capability to predict CTEPH. Ventilatory inefficiency improves along with recovery of acute PE. |
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Keywords: | 6MWD, 6-min walking distances AT, anaerobic threshold BMI, body mass index BR, breathing reserve BSA, body surface area CI, cardiac index CPET, cardiopulmonary exercise testing CTEPH, chronic thromboembolic pulmonary hypertension CTPA, computed tomographic pulmonary angiogram Fb, breathing frequency FEV1, forced expiratory volume in one second FVC, forced vital capacity HR, heart rate LVED, left ventricular end-diastolic diameter mPAP, mean pulmonary arterial pressure mRAP, mean right atrial pressure NT-proBNP, N-terminal pro-brain natriuretic peptide OR, odds ratio OUEP, oxygen uptake efficiency plateau PDE, phosphodiesterase PE, pulmonary embolism PETCO2, end-tidal partial pressure of CO2 PH, pulmonary hypertension PVO, the percentage of vascular obstruction by ventilation-perfusion lung scanning PVR, pulmonary vascular resistance RER, respiratory exchange rate RHC, right heart catheterization ROC, receiver operator characteristic curve RVED, right ventricular end-diastolic diameter SD, standard deviation VE, minute ventilation VCO2, CO2 production VO2, oxygen uptake VD/VTphys, physiologic dead space fraction WHO-FC, World Health Organization functional class |
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