Cardiopulmonary exercise testing in the assessment of pulmonary hypertension

Expert Review of Respiratory Medicine

Volumn 5, Issue 2, 2011, Pages 281-293

  Arena, Ross ^a   Guazzi, Marco ^b   Myers, Jonathan ^c   Grinnen, Daniel ^a   Forman, Daniel E ^d,e   Lavie, Carl J ^f  

^a VIRGINIA COMMONWEALTH UNIVERSITY   (United States)

^b UNIVERSITY OF MILAN   (Italy)

^c VA PALO ALTO HEALTH CARE SYSTEM   (United States)

^d BRIGHAM AND WOMEN S HOSPITAL   (United States)

^e VA BOSTON HEALTHCARE SYSTEM   (United States)

^f UNIVERSITY OF QUEENSLAND   (Australia)

Author keywords

aerobic capacity; carbon dioxide production; diagnosis; minute ventilation; prognosis; pulmonary vasculopathy; ventilatory efficiency

Indexed keywords

CARBON DIOXIDE;

AEROBIC EXERCISE; ARTERIAL OXYGEN TENSION; BLOOD GAS; BREATH ANALYSIS; CARDIOPULMONARY EXERCISE TEST; CHRONIC OBSTRUCTIVE LUNG DISEASE; CLINICAL FEATURE; CLINICAL PRACTICE; DYSPNEA; ECHOCARDIOGRAPHY; END TIDAL CARBON DIOXIDE TENSION; FUNCTIONAL STATUS; HEART FAILURE; HEART OUTPUT; HUMAN; HYPERTROPHIC CARDIOMYOPATHY; LUNG FIBROSIS; LUNG HEMODYNAMICS; LUNG MINUTE VOLUME; LUNG PRESSURE; LUNG VENTILATION PERFUSION RATIO; OXYGEN CONSUMPTION; PATHOPHYSIOLOGY; PATIENT CODING; PULMONARY HYPERTENSION; PULSE OXIMETRY; REVIEW;

EID: 79955379475     PISSN: 17476348     EISSN: 17476356     Source Type: Journal    
DOI: 10.1586/ers.11.4     Document Type: Review

References (88)

1. Sanchez O, Marie E, Lerolle U et al. Pulmonary arterial hypertension in women. Rev. Mal. Respir. 27(8) e79-e87 (2010).
2. De MT. Pulmonary arterial hypertension and women. Cardiol. Rev. 14(6), 312-318 (2006).
3. Galie N, Hoeper MM, Humbert M et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur. Respir. J. 34(6), 1219-1263 (2009).
4. Humbert M, Sitbon O, Simonneau G. Treatment of pulmonary arterial hypertension. N. Engl. J. Med. 351(14), 1425-1436 (2004).
5. McGoon M, Gutterman D, Steen V et al. Screening, early detection, and diagnosis of pulmonary arterial hypertension. Chest 126(Suppl. 1) 14S-34S (2004).
6. Steen V, Chou M, Shanmugam V et al. Exercise-induced pulmonary arterial hypertension in patients with systemic sclerosis. Chest 134(1), 146-151 (2008). (Pubitemid 352008776)
7. Thomas AQ, Gaddipati R, Newman JH, Loyd JE. Genetics of primary pulmonary hypertension. Clin. Chest Med. 22(3), 477-491, IX (2001). (Pubitemid 32912080)
8. Rich S, Dantzker DR, Ayres SM et al. Primary pulmonary hypertension. A national prospective study. Ann. Intern. Med. 107(2), 216-223 (1987). (Pubitemid 17137857)
9. Arena R, Lavie CJ, Milani RV, Myers J, Guazzi M. Cardiopulmonary exercise testing in patients with pulmonary arterial hypertension: an evidence-based review. J. Heart Lung Transplant. 29(2), 159-173 (2010).
10. Damy T, Goode KM, Kallvikbacka-Bennett A et al. Determinants and prognostic value of pulmonary arterial pressure in patients with chronic heart failure. Eur. Heart J. 31(18), 2280-2290 (2010).
11. Adhyapak SM. Effect of right ventricular function and pulmonary pressures on heart failure prognosis. Prev. Cardiol. 13(2), 72-77 (2010).
12. Minai OA, Chaouat A, Adnot S. Pulmonary hypertension in COPD: epidemiology, significance, and management. Chest 137(Suppl. 6) 39S-51S (2010).
13. Park MH, Scott RL, Uber PA, Ventura HO, Mehra MR. Usefulness of B-type natriuretic peptide as a predictor of treatment outcome in pulmonary arterial hypertension. Congest. Heart Fail. 10(5), 221-225 (2004).
14. Hinderliter AL, Willis PW, Barst RJ et al. Effects of long-term infusion of prostacyclin (epoprostenol) on echocardiographic measures of right ventricular structure and function in primary pulmonary hypertension. Primary Pulmonary Hypertension Study Group. Circulation 95(6), 1479-1486 (1997). (Pubitemid 27142806)
15. Groepenhoff H, Vonk-Noordegraaf A, Boonstra A et al. Exercise testing to estimate survival in pulmonary hypertension. Med. Sci. Sports Exerc. 40(10), 1725-1732 (2008).
16. Balady GJ, Arena R, Sietsema K et al. Clinician's guide to cardiopulmonary exercise testing in adults. a scientific statement from the American Heart Association. Circulation 122(2), 191-225 (2010).
17. Gibbons RJ, Balady GJ, Timothy BJ et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J. Am. Coll. Cardiol. 40(8), 1531-1540 (2002).
18. Wasserman K, Hansen JE, Sue DY, Whipp BJ. Principles of Exercise Testing and Interpretation. Lea and Febiger, Philadelphia, PA, USA (2005).
19. Hsia CC, Johnson RL Jr. Comprehensive Textbook of Pulmonary and Critical Care Medicine. Bone R (Ed.). Mosby-Yearbook, St Louis, MO, USA, 1-20 (1993).
20. D'Alonzo GE, Gianotti LA, Pohil RL et al. Comparison of progressive exercise performance of normal subjects and patients with primary pulmonary hypertension. Chest 92(1), 57-62 (1987). (Pubitemid 17101336)
21. Yasunobu Y, Oudiz RJ, Sun XG, Hansen JE, Wasserman K. End-tidal PCO2 abnormality and exercise limitation in patients with primary pulmonary hypertension. Chest 127(5), 1637-1646 (2005). (Pubitemid 46218789)
22. Sun XG, Hansen JE, Oudiz RJ, Wasserman K. Gas exchange detection of exercise-induced right-to-left shunt in patients with primary pulmonary hypertension. Circulation 105(1), 54-60 (2002). (Pubitemid 34049142)
23. Arena R, Myers J, Williams MA et al. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation 116(3), 329-343 (2007). (Pubitemid 47196569)
24. Tji-Joong Gan C, Lankhaar JW, Marcus JT et al. Impaired left ventricular filling due to right-to-left ventricular interaction in patients with pulmonary arterial hypertension. Am. J. Physiol. Heart Circ. Physiol. 290(4) H1528-H1533 (2006).
25. Sun XG, Hansen JE, Oudiz RJ, Wasserman K. Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation 104(4), 429-435 (2001). (Pubitemid 32678273)
26. Mainguy V, Maltais F, Saey D et al. Peripheral muscle dysfunction in idiopathic pulmonary arterial hypertension. Thorax 65, 113-117 (2010).
27. Rich S. The effects of vasodilators in pulmonary hypertension: pulmonary vascular or peripheral vascular? Circ. Heart Fail. 2(2), 145-150 (2009).
28. Rich S. Executive Summary from the World Symposium on Primary Pulmonary Hypertension. World Health Organization, Evian, France (1998).
29. Jing ZC, Xu XQ, Han ZY et al. Registry and survival study in Chinese patients with idiopathic and familial pulmonary arterial hypertension. Chest 132(2), 373-379 (2007).
30. Herrera EL, Zarate JS, Solano JF et al. Clinical-hemodynamic correlation of the NYHA/WHO system in idiopathic pulmonary artery hypertension. Clinical, therapeutic and long-term prognosis implications Arch. Cardiol. Mex. 78(2), 148-161 (2008).
31. Taichman DB, McGoon MD, Harhay MO et al. Wide variation in clinicians' assessment of New York Heart Association/World Health Organization functional class in patients with pulmonary arterial hypertension. Mayo Clin. Proc. 84(7), 586-592 (2009).
32. Hansen JE, Sun XG, Yasunobu Y et al. Reproducibility of cardiopulmonary exercise measurements in patients with pulmonary arterial hypertension. Chest 126(3), 816-824 (2004). (Pubitemid 39258036)
33. Arena R, Myers J, Guazzi M. The clinical and research applications of aerobic capacity and ventilatory efficiency in heart failure: an evidence-based review. Heart Fail. Rev. 13(2), 245-269 (2008).
34. Hambrecht RP, Schuler GC, Muth T et al. Greater diagnostic sensitivity of treadmill versus cycle exercise testing of asymptomatic men with coronary artery disease. Am. J. Cardiol. 70(2), 141-146 (1992).
35. Valli G, Vizza CD, Onorati P et al. Pathophysiological adaptations to walking and cycling in primary pulmonary hypertension. Eur. J. Appl. Physiol. 102(4), 417-424 (2008).
36. Myers J, Voodi L, Umann T, Froelicher VF. A survey of exercise testing: methods, utilization, interpretation, and safety in the VAHCS. J. Cardiopulm. Rehabil. 20(4), 251-258 (2000). (Pubitemid 30618629)
37. Balke B, Ware RW. An experimental study of physical fitness of Air Force personnel. US Armed Forces Med. J. 10(6), 675-688 (1959).
38. Naughton J, Balke B, Nagle F. Refinements in method of evaluation of physical conditioning before and after myocardial infarction. Am. J. Cardiol. 14, 837-843 (1964).
39. Myers J, Bellin D. Ramp exercise protocols for clinical and cardiopulmonary exercise testing. Sports Med. 30(1), 23-29 (2000). (Pubitemid 30449783)
40. Humbert M. Pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: pathophysiology. Eur. Respir. Rev. 19(115), 59-63 (2010).
41. Janicki JS, Weber KT, Likoff MJ, Fishman AP. Exercise testing to evaluate patients with pulmonary vascular disease. Am. Rev. Respir. Dis. 129(2 Pt 2) S93-S95 (1984). (Pubitemid 14190994)
42. Wensel R, Opitz CF, Anker SD et al. Assessment of survival in patients with primary pulmonary hypertension: importance of cardiopulmonary exercise testing. Circulation 106(3), 319-324 (2002). (Pubitemid 34778955)
43. Hansen JE, Ulubay G, Chow BF, Sun XG, Wasserman K. Mixed-expired and end-tidal CO2 distinguish between ventilation and perfusion defects during exercise testing in patients with lung and heart diseases. Chest 132(3), 977-983 (2007).
44. Glaser S, Noga O, Koch B et al. Impact of pulmonary hypertension on gas exchange and exercise capacity in patients with pulmonary fibrosis. Respir. Med. 103(2), 317-324 (2009).
45. Deboeck G, Niset G, Lamotte M, Vachiery JL, Naeije R. Exercise testing in pulmonary arterial hypertension and in chronic heart failure. Eur. Respir. J. 23(5), 747-751 (2004). (Pubitemid 38618147)
46. Tolle JJ, Waxman AB, Van Horn TL, Pappagianopoulos PP, Systrom DM. Exercise-induced pulmonary arterial hypertension. Circulation 118(21), 2183-2189 (2008).
47. Ha JW, Choi D, Park S et al. Determinants of exercise-induced pulmonary hypertension in patients with normal left ventricular ejection fraction. Heart 95(6), 490-494 (2009).
48. Reindl I, Wernecke KD, Opitz C et al. Impaired ventilatory efficiency in chronic heart failure: possible role of pulmonary vasoconstriction. Am. Heart J. 136(5), 778-785 (1998). (Pubitemid 28506876)
49. Paciocco G, Martinez FJ, Bossone E et al. Oxygen desaturation on the six-minute walk test and mortality in untreated primary pulmonary hypertension. Eur. Respir. J. 17(4), 647-652 (2001). (Pubitemid 32492552)
50. Uren NG, Davies SW, Agnew JE et al. Reduction of mismatch of global ventilation and perfusion on exercise is related to exercise capacity in chronic heart failure. Br. Heart J. 70(3), 241-246 (1993). (Pubitemid 23276235)
51. Wada O, Asanoi H, Miyagi K et al. Importance of abnormal lung perfusion in excessive exercise ventilation in chronic heart failure. Am. Heart J. 125(3), 790-798 (1993). (Pubitemid 23079848)
52. Ponikowski P, Francis DP, Piepoli MF et al. Enhanced ventilatory response to exercise in patients with chronic heart failure and preserved exercise tolerance: marker of abnormal cardiorespiratory reflex control and predictor of poor prognosis. Circulation 103(7), 967-972 (2001). (Pubitemid 32183802)
53. Reybrouck T, Mertens L, Schulze-Neick I et al. Ventilatory inefficiency for carbon dioxide during exercise in patients with pulmonary hypertension. Clin. Physiol. 18(4), 337-344 (1998).
54. Jin X, Weil MH, Tang W et al. End-tidal carbon dioxide as a noninvasive indicator of cardiac index during circulatory shock. Crit. Care Med. 28(7), 2415-2419 (2000). (Pubitemid 30604447)
55. Ornato JP, Garnett AR, Glauser FL. Relationship between cardiac output and the end-tidal carbon dioxide tension. Ann. Emerg. Med. 19(10), 1104-1106 (1990). (Pubitemid 20365198)
56. Lewis GD, Shah RV, Pappagianopolas PP, Systrom DM, Semigran MJ. Determinants of ventilatory efficiency in heart failure: the role of right ventricular performance and pulmonary vascular tone. Circ. Heart Fail. 1(4), 227-233 (2008).
57. American Thoracic Society and American College of Chest Physicians ATS/ACCP. statement on cardiopulmonary exercise testing. Am. J. Respir. Crit. Care Med. 167, 211-277 (2003).
58. Ridruejo R, Serrano P, Pascual I et al. Six-minute walk test in pulmonary hypertension of any etiology. Arch. Med. 1(2), 1-7 (2009).
59. James KB, Maurer J, Wolski K et al. Exercise hemodynamic findings in patients with exertional dyspnea. Tex. Heart Inst. J. 27(2), 100-105 (2000). (Pubitemid 30464034)
60. Proudman SM, Stevens WM, Sahhar J, Celermajer D. Pulmonary arterial hypertension in systemic sclerosis: the need for early detection and treatment. Intern. Med. J. 37(7), 485-494 (2007). (Pubitemid 46855082)
61. Raeside DA, Chalmers G, Clelland J, Madhok R, Peacock AJ. Pulmonary artery pressure variation in patients with connective tissue disease: 24 hour ambulatory pulmonary artery pressure monitoring. Thorax 53(10), 857-862 (1998). (Pubitemid 28459542)
62. Mereles D, Ehlken N, Kreuscher S et al. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation 114(14), 1482-1489 (2006). (Pubitemid 44527003)
63. Capomolla S, Febo O, Caporotondi A et al. Non-invasive estimation of right atrial pressure by combined Doppler echocardiographic measurements of the inferior vena cava in patients with congestive heart failure. Ital. Heart J. 1(10), 684-690 (2000).
64. Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am. J. Cardiol. 66(4), 493-496 (1990). (Pubitemid 20259386)
65. Bossone E, Bodini BD, Mazza A, Allegra L. Pulmonary arterial hypertension: the key role of echocardiography. Chest 127(5), 1836-1843 (2005). (Pubitemid 46218815)
66. Tischler MD, Battle RW, Saha M, Niggel J, LeWinter MM. Observations suggesting a high incidence of exercise-induced severe mitral regurgitation in patients with mild rheumatic mitral valve disease at rest. J. Am. Coll. Cardiol. 25(1), 128-133 (1995).
67. Tolle J, Waxman A, Systrom D. Impaired systemic oxygen extraction at maximum exercise in pulmonary hypertension. Med. Sci. Sports Exerc. 40(1), 3-8 (2008).
68. Ferrazza AM, Martolini D, Valli G, Palange P. Cardiopulmonary exercise testing in the functional and prognostic evaluation of patients with pulmonary diseases. Respiration 77(1), 3-17 (2009).
69. Miyamoto S, Nagaya N, Satoh T et al. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. Am. J. Respir. Crit. Care Med. 161(2), 487-492 (2000). (Pubitemid 30129457)
70. Riley MS, Porszasz J, Engelen MP, Brundage BH, Wasserman K. Gas exchange responses to continuous incremental cycle ergometry exercise in primary pulmonary hypertension in humans. Eur. J. Appl. Physiol. 83(1), 63-70 (2000). (Pubitemid 32015608)
71. Nagaya N, Shimizu Y, Satoh T et al. Oral beraprost sodium improves exercise capacity and ventilatory efficiency in patients with primary or thromboembolic pulmonary hypertension. Heart 87(4), 340-345 (2002). (Pubitemid 34270946)
72. Oudiz RJ, Roveran G, Hansen JE, Sun XG, Wasserman K. Effect of sildenafil on ventilatory efficiency and exercise tolerance in pulmonary hypertension. Eur. J. Heart Fail. 9(9), 917-921 (2007). (Pubitemid 47332322)
73. Oudiz RJ, Midde R, Hovenesyan A et al. Usefulness of right-to-left shunting and poor exercise gas exchange for predicting prognosis in patients with pulmonary arterial hypertension. Am. J. Cardiol. 105(8), 1186-1191 (2010).
74. Yetman AT, Taylor AL, Doran A, Ivy DD. Utility of cardiopulmonary stress testing in assessing disease severity in children with pulmonary arterial hypertension. Am. J. Cardiol. 95(5), 697-699 (2005). (Pubitemid 40255276)
75. Raeside DA, Smith A, Brown A et al. Pulmonary artery pressure measurement during exercise testing in patients with suspected pulmonary hypertension. Eur. Respir. J. 16(2), 282-287 (2000). (Pubitemid 30624947)
76. Chenivesse C, Rachenne V, Fournier C et al. Cardiopulmonary exercise testing in exercise-induced pulmonary hypertension. Rev. Mal. Respir. 23(2 Pt 1) 141-148 (2006). (Pubitemid 43926738)
77. Stone CD, Hennein HA, McIntosh CL et al. The results of operation in patients with hypertrophic cardiomyopathy and pulmonary hypertension. J. Thorac. Cardiovasc. Surg. 100(3), 343-351 (1990).
78. Romeo F, Pelliccia F, Cristofani R, Martuscelli E, Reale A. Hypertrophic cardiomyopathy: is a left ventricular outflow tract gradient a major prognostic determinant? Eur. Heart J. 11(3), 233-240 (1990). (Pubitemid 20119787)
79. Weitzenblum E, Chaouat A, Canuet M, Kessler R. Pulmonary hypertension in chronic obstructive pulmonary disease and interstitial lung diseases. Semin. Respir. Crit. Care Med. 30(04), 458-470 (2009).
80. Oudiz RJ. Pulmonary hypertension associated with left-sided heart disease. Clin. Chest Med. 28(1), 233-241 (2007). (Pubitemid 46350735)
81. Ukkonen H, Burwash IG, Dafoe W et al. Is ventilatory efficiency (VE/VCO2 slope) associated with right ventricular oxidative metabolism in patients with congestive heart failure? Eur. J. Heart Fail. 10(11), 1117-1122 (2008).
82. Ferreira AM, Tabet JY, Frankenstein L et al. Ventilatory efficiency and the selection of patients for heart transplantation. Circ. Heart Fail. 3(3), 378-386 (2010).
83. Arena R, Myers J, Abella J et al. Development of a ventilatory classification system in patients with heart failure. Circulation 115(18), 2410-2417 (2007). (Pubitemid 46717963)
84. Arena R, Owens DS, Arevalo J et al. Ventilatory efficiency and resting hemodynamics in hypertrophic cardiomyopathy. Med. Sci. Sports Exerc. 40(5), 799-805 (2008).
85. Vonbank K, Funk GC, Marzluf B et al. Abnormal pulmonary arterial pressure limits exercise capacity in patients with COPD. Wien. Klin. Wochenschr. 120(23-24), 749-755 (2008).
86. Holverda S, Bogaard HJ, Groepenhoff H et al. Cardiopulmonary exercise test characteristics in patients with chronic obstructive pulmonary disease and associated pulmonary hypertension. Respiration 76(2), 160-167 (2008).
87. Callejas-Rubio JL, Moreno-Escobar UA, de la Fuente PM et al. Prevalence of exercise pulmonary arterial hypertension in scleroderma. J. Rheumatol. 35(9), 1812-1816 (2008).
88. Barst RJ, Langleben D, Frost A et al. Sitaxsentan therapy for pulmonary arterial hypertension. Am J. Respir. Crit. Care Med. 169(4), 441-447 (2004). (Pubitemid 38187114)