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          Institute: MPI für Herz- und Lungenforschung (W. G. Kerckhoff Institut)     Collection: Yearbook 2016     Display Documents



ID: 723933.0, MPI für Herz- und Lungenforschung (W. G. Kerckhoff Institut) / Yearbook 2016
Pulmonary Hemodynamic Response to Exercise in Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy
Authors:Richter, M. J.; Sommer, N.; Gall, H.; Voswinckel, R.; Seeger, W.; Mayer, E.; Wiedenroth, C. B.; Rieth, A.; Grimminger, F.; Guth, S.; Ghofrani, H. A.
Date of Publication (YYYY-MM-DD):2015
Title of Journal:Respiration
Volume:90
Issue / Number:1
Start Page:63
End Page:73
Audience:Not Specified
Abstract / Description:BACKGROUND: Pulmonary endarterectomy (PEA) is the treatment of choice in surgically accessible chronic thromboembolic pulmonary hypertension (CTEPH). An important predictor of outcome is postsurgical residual pulmonary hypertension. OBJECTIVE: We aimed to use the hemodynamic response during exercise before PEA as a measurement for the hemodynamic outcome 1 year after PEA. METHODS: Between January 2011 and December 2013, 299 patients underwent PEA in our center. A total of 16 patients who were assessed by means of invasive hemodynamic measurements during exercise both at baseline and 1 year after PEA were retrospectively analyzed. RESULTS: Pre-PEA mean pulmonary arterial pressure (mPAP) increased during exercise from 35.8 +/- 7.6 to 53.8 +/- 5.1 mm Hg, diastolic pulmonary arterial pressure (dPAP) from 21.5 +/- 5.6 to 30.3 +/- 9.6 mm Hg, cardiac output (CO) from 4.4 +/- 0.8 to 6.5 +/- 1.9 l/min and diastolic pulmonary gradient (DPG) from 14.6 +/- 4.9 to 20.7 +/- 12.7 mm Hg. Post-PEA mPAP increased from 23.7 +/- 6.6 at rest to 43.2 +/- 7.1 mm Hg, while CO increased to a higher extent from 5.1 +/- 0.9 to 8.4 +/- 1.9 l/min. There were significant correlations between pre-PEA DPG/CO and dPAP/CO slopes with the pulmonary vascular resistance (Spearman r = 0.578, p = 0.019, and r = 0.547, p = 0.028) and mPAP at rest after PEA (Spearman r = 0.581, p = 0.018, and r = 0.546, p = 0.028). CONCLUSIONS: In CTEPH, the presurgical dynamic DPG/CO and dPAP/CO slopes during submaximal exercise are associated with the hemodynamic outcome 1 year after PEA.
External Publication Status:published
Document Type:Article
Communicated by:n.n.
Affiliations:MPI für physiologische und klinische Forschung
Identifiers:ISSN:1423-0356 (Electronic) 0025-7931 (Linking) %R 10.1159/000398815
URL:http://www.ncbi.nlm.nih.gov/pubmed/26044754
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