Exercise and pulsatile pulmonary vascular loading in chronic thromboembolic pulmonary disease

Author:

Osman Sinan12ORCID,Girdharry Natasha R.12,Karvasarski Elizabeth12,Bentley Robert F.3,Wright Stephen P.4,Sharif Nadia5ORCID,McInnis Micheal6,Granton John T.5,dePerrot Marc7,Mak Susanna12ORCID

Affiliation:

1. Division of Cardiology Mount Sinai Hospital/University Health Network Toronto Ontario Canada

2. Institute of Medical Science University of Toronto Toronto Ontario Canada

3. Faculty of Kinesiology and Physical Education University of Toronto Toronto Ontario Canada

4. School of Health and Exercise Sciences, Centre for Heart, Lung and Vascular Health University of British Columbia Kelowna British Columbia Canada

5. Department of Medicine, Division of Respirology University Health Network Toronto Ontario Canada

6. Department of Medical Imaging University of Toronto Toronto Ontario Canada

7. Department of Surgery, Division of Thoracic Surgery University of Toronto Toronto Ontario Canada

Abstract

AbstractChronic thromboembolic pulmonary disease (CTEPD) is characterized by organized nonresolving thrombi in pulmonary arteries (PA). In CTEPD with pulmonary hypertension (PH), chronic thromboembolic PH (CTEPH), early wave reflection results in abnormalities of pulsatile afterload and augmented PA pressures. We hypothesized that exercise during right heart catheterization (RHC) would elicit more frequent elevations of pulsatile vascular afterload than resistive elevations in patients with CTEPD without PH. The interdependent physiology of pulmonary venous and PA hemodynamics was also evaluated. Consecutive patients with CTEPD without PH (resting mean PA pressure ≤20 mmHg) undergoing an exercise RHC were identified. Latent resistive and pulsatile abnormalities of pulmonary vascular afterload were defined as an exercise mean PA pressure/cardiac output >3 WU, and PA pulse pressure to PA wedge pressure (PA PP/PAWP) ratio >2.5, respectively. Forty‐five patients (29% female, 53 ± 14 years) with CTEPD without PH were analyzed. With exercise, 19 patients had no abnormalities (ExNOR), 26 patients had abnormalities (ExABN) of pulsatile (20), resistive (2), or both (4) elements of pulmonary vascular afterload. Exercise elicited elevations of pulsatile afterload (53%) more commonly than resistive afterload (13%) (p < 0.001). ExABN patients had lower PA compliance and higher pulmonary vascular resistance at rest and exercise and prolonged resistance‐compliance time product at rest. The physiological relationship between changes in PA pressures relative to PAWP was disrupted in the ExABN group. In CTEPD without PH, exercise RHC revealed latent pulmonary vascular afterload elevations in 58% of patients with more frequent augmentation of pulsatile than resistive pulmonary vascular afterload.

Funder

Ontario Research Foundation

Publisher

Wiley

Subject

Pulmonary and Respiratory Medicine

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