Right Ventricular Response During Exercise in Patients with Chronic Obstructive Pulmonary Disease.
AIM
Right ventricular (RV) pump function is of essential clinical and prognostic importance in a variety of heart and lung diseases. While the evaluation of RV performance at rest has been implemented in the clinical setting, it is unknown whether this assessment during exercise may provide additional benefit. With this aim, we evaluated the exercise-induced pulmonary arterial systolic pressure (PASP) increase during exercise in patients with severe chronic obstructive pulmonary disease (COPD) as an expression of RV contractile reserve.


METHOD
Cardiopulmonary exercise testing (CPET) with synchronic echocardiography was performed in 81 patients. Patients were classified into two groups according to an exercise-induced PASP increase above 30mmHg (High PSAP) or below 30mmHg (Low PSAP) during maximal exercise. Patients were then followed for three years.


RESULTS
Sixteen patients (20%) had low PSAP and 65 (80%) showed high PSAP. These were not significant clinical and functional differences. Low PSAP was associated with a significantly lower peak VO2 (mean (SD), 35 (2) % predicted) compared to high PSAP response (peak VO2 45 (3) % predicted), p=0.045. Factors associated with mortality were age and exercise-induced PASP. Seventeen patients died during the three years of follow-up (7 (39%) in the low PSAP group and only 10 (1%) in the high PSAP group, p=0.041).


CONCLUSION
Cardiopulmonary exercise testing with a synchronic echocardiography may be a useful tool for the assessment of RV contractile reserve in severe COPD patients. Exercise-induced PSAP emerges as a possible prognostic factor in these patients.
['Rodríguez|Diego A|DA|', 'Sancho-Muñoz|Antonio|A|', 'Rodó-Pin|Anna|A|', 'Herranz|Anna|A|', 'Gea|Joaquim|J|', 'Bruguera|Jordi|J|', 'Molina|Lluis|L|']
D000368:Aged D018572:Disease-Free Survival D004452:Echocardiography D005080:Exercise Test D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D029424:Pulmonary Disease, Chronic Obstructive D015996:Survival Rate D016278:Ventricular Function, Right
right ventricular response exercise COPD