Abstract
BackgroundAfter successful pulmonary endoarterectomy (PEA), patients may still suffer from exercise limitation, despite normal pulmonary vascular resistance. We sought to assess the proportion of these patients after the extension of PEA to frail patients, and the determinants of exercise limitation.MethodsOut of 553 patients treated with PEA from 2008 to 2016 at our institution, a cohort of 261 patients was followed up at 12 months. They underwent clinical, haemodynamic, echocardiographic, respiratory function tests and treadmill exercise testing. A reduced exercise capacity was defined as Bruce test distance < 400 m.ResultsEighty patients did not had exercise testing because of inability to walk on treadmill and/or ECG abnormalities Exercise limitation 12 months after PEA was present in 74/181 patients (41, 95%CI 34 to 48%). The presence of COPD was more than double in patients with exercise limitation than in the others. Patients with persistent exercise limitation had significantly higher mPAP, PVR, HR and significantly lower RVEF, PCa, CI, VC, TLC, FEV1, FEV1/VC, DLCO, HbSaO2 than patients without. The multivariable model shows that PCa at rest and TAPSE are important predictors of exercise capacity. Age, COPD, respiratory function parameters and unilateral surgery were also retained.ConclusionsAfter successful PEA, most of the patients recovered good exercise tolerance. However, about 40% continues to suffer from limitation to a moderate intensity exercise. Besides parameters of right ventricular function, useful information are provided by respiratory function parameters and COPD diagnosis. This could be useful to better address the appropriate therapeutic approach.
Highlights
After successful pulmonary endoarterectomy (PEA), patients may still suffer from exercise limitation, despite normal pulmonary vascular resistance
The present study shows that: 1) a persistent reduced exercise capacity is present in a substantial proportion of chronic thromboembolic pulmonary hypertension (CTEPH) patients who have undergone PEA despite normalization of pulmonary vascular resistance; 2) this limitation is characterized by a multifactorial etiology involving respiratory function abnormalities
Confirming the importance of airflow obstruction, we found that forced expiratory volume in 1 s (FEV1)/vital capacity (VC) is an independent predictor of reduced exercise capacity
Summary
After successful pulmonary endoarterectomy (PEA), patients may still suffer from exercise limitation, despite normal pulmonary vascular resistance. It is recognized that after PEA, successfully operated patients can continue to suffer from a limitation of exercise capacity [9]. Many studies aimed to explore the cardiopulmonary exercise test (CPET) profile and the pulmonary response to exercise. Most of the Corsico et al Respiratory Research (2019) 20:34 previous series used sophisticated and complex protocols addressed to study the pathophysiological mechanisms by CPET and included a very small number of patients. This precluded the evaluation of the proportion of patients with exercise limitation after PEA. The simple 6-min walking test has gained popularity, albeit it provides different information, being less demanding that CPET and imprecise in answering important clinical questions [12]
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