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Comparative Study
. 2014 Jul;19(5):675-82.
doi: 10.1111/resp.12306. Epub 2014 May 6.

Impact of pulmonary hypertension on exercise performance in patients with interstitial lung disease undergoing evaluation for lung transplantation

Hilary F Armstrong  1 , P Christian Schulze, Matthew Bacchetta, Wilawan Thirapatarapong, Matthew N Bartels
Affiliations
Comparative Study

Impact of pulmonary hypertension on exercise performance in patients with interstitial lung disease undergoing evaluation for lung transplantation

Hilary F Armstrong et al. Respirology. 2014 Jul.

Abstract

Background and objective: Pulmonary hypertension (PH) is a known complication in patients with interstitial lung disease (ILD). Cardiopulmonary exercise testing (CPET) is an essential tool for the assessment of patients with cardiac and pulmonary diseases due to its prognostic and therapeutic implications. Few studies have evaluated the relationship between CPET response and mean pulmonary artery pressures (mPAP) in ILD. The purpose of the present study was to determine and compare the potential correlations between CPET, 6-min walk test (6MWT), pulmonary function testing (PFT) and PH in patients with ILD being evaluated for lung transplantation.

Methods: The present study reviewed patients with ILD who received lung transplantations and had CPETs within 2 years before transplantation, right heart catheterizations, PFTs and 6MWTs within 4 months of CPET.

Results: A total of 72 patients with ILD were analysed; 36% had PH. There were significant correlations between mPAP and CPET parameters in patients with PH; but mPAP had no impact on percent of predicted diffusion capacity of the lung for carbon monoxide or 6-min walk distance (6MWD). CPET parameters were able to detect differences between levels of severity of PH through the use of the ratio of minute ventilation to rate of carbon dioxide production (VE/VCO2) and the partial pressure of end-tidal carbon dioxide.

Conclusions: This is the first study that analyses 6MWD, PFT and CPET in patients with ILD awaiting lung transplantation with and without PH. The present study demonstrates the significant impact of PH on exercise capacity and performance in patients with ILD awaiting lung transplantation.

Keywords: cardiopulmonary exercise test; interstitial lung disease; lung transplantation; pulmonary hypertension; respiratory insufficiency.

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Figures

Figure 1
Figure 1. Peak partial pressure of end-tidal carbon dioxide (PetCO2) as a function of mean pulmonary arterial pressure (mPAP) in patients with pulmonary hypertension
The curve through the data points was determined by quadratic modeling.
Figure 2
Figure 2. Patients with ILD-Peak V̇E/V̇CO2 and PetCO2 according to severity of resting pulmonary hypertension
The peak ratio of minute ventilation to rate of carbon dioxide produced (V̇E/V̇CO2) and partial pressure of end-tidal carbon dioxide (PetCO2) were significantly different (*p≤0.05) between the patients with severe pulmonary hypertension (≥40 mmHg) compared to those with mild to moderate (25-39 mmHg) or no pulmonary hypertension (<25 mmHg). With increasing severity of pulmonary pressures, the VE/VCO2 increased while the PetCO2 decreased.
Figure 3
Figure 3. ROC Curves
Receiver operating characteristic (ROC) curves for severe pulmonary hypertension at rest. The area under the curve was 98% (p-value<0.001) for partial pressure of end-tidal carbon dioxide (PetCO2), 82% (p-value=0.018) for percent of predicted diffusion capacity of the lung for carbon monoxide (DLCO %), and 62% (p-value=0.375) for 6-minute walk distance (6MWD).
See this image and copyright information in PMC

Comment in

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