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Really worth the effort: unveiling exercise pulmonary hypertension – a single centre experience
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 17 - REABILITAÇÃO CARDÍACA: ESTRATIFICAÇÃO DE RISCO, IMPACTO DO EXERCÍCIO E O PAPEL DA EDUCAÇÃO NA MELHORIA DOS RESULTADOS DOS DOENTES
Speaker:
João Mirinha Luz
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.3 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Mirinha Luz; Otília Simões; Filipa Ferreira; Sofia Alegria; Rita Calé; Bárbara Marques Ferreira; Ana Cláudia Vieira; Débora Repolho; Sílvia Vitorino; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction and aim:</strong> The 2022 ESC/ERS Pulmonary Hypertension (PH) guidelines brought us the definition of exercise pulmonary hypertension (E-PH), characterized by a mean pulmonary artery pressure to cardiac output ratio (mPAP/CO) slope above 3 mmHg/L/min, assessed by exercise right heart catheterization (E-RHC). Cardiopulmonary exercise test (CPET), though the evaluation of some metabolic parameters, could evaluate the probability of presence of PH. The aim of this study was to correlate parameters obtained in CPET, in predicting presence of E-PH in E-RHC. This study reflects the 2-plus years of evaluating patients with suspected E-PH.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> We performed an observational, cross-sectional and unicentric study that included patients (pts) with dyspnea on effort, with risk factors for PH, but with low echocardiographic probability and normal NTproBNP. Pts were subjected to sequential CPET and E-RHC between January 2022 to October 2024. CPET was performed in a treadmill, using staged protocols - Bruce and modified Bruce. E-RHC used a protocol of 15 minutes (mts) in total, with stepwise workload increase of 10 Watts every 3 mts, and mPAP/CO slope was evaluated at peak effort. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Twenty-nine pts were included. Median age at the time of CPET was 64 years-old. Main diagnosis was chronic thromboembolic disease (CTED), including patients who previously were subjected to pulmonary endarterectomy and had no residual PH or patients with CTED who had been treated with ballon pulmonary angioplasty. Modified Bruce was the main protocol used for CPET (86%, n=25), with mean effort time of 10.6+-2.7 mts. Regarding E-RHC, 93% of patients performed 9 or more minutes of exercise. Twenty pts (69%) had confirmed E-PH, with mean mPAP/CO slope in peak exercise of 4.62mmHg/L/min. In pts with confirmed E-PH, VE/VCO2 slope was significantly higher (38.25 vs 32.88, p=0.013), but no differences were seen regarding percentage of VO2 peak or PETCO2 at anaerobic threshold (AT) (table 1). Using a cutoff of 34 for respiratory equivalent for CO2 at first AT, we’ve seen more pts with confirmed E-PH with values above 34, but no statistical difference was obtained (p=0.08).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> Our study shows that CPET could be a paramount exam regarding evaluation of pts at risk for E-PH, with documented differences in VE/VCO2 slope. This study also shows that larger cohorts are needed to define the optimal cutoff values to define higher probability of E-PH, predicting the need for E-RHC or not. </span></span></p>
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