Key result
Exercise training in PAH may risk long-term myocardial maladaptation despite short-term benefits.
Why the study?
Despite short-term efficacy of exercise training in PAH, exercise causes abnormal pulmonary hemodynamics and high RV afterload, raising concerns that repetitive training might promote myocardial maladaptive remodeling.
Does exercise training improve outcomes safely in patients with pulmonary arterial hypertension?
Does exercise training improve outcomes safely in patients with pulmonary arterial hypertension?
Risk stratification based on pulmonary hemodynamic responses to exercise is necessary before prescribing exercise training to patients with PAH to minimize the risk of right ventricular maladaptive remodeling.
Answers are grounded in this paper and cite their sources.
May warrant caution with repetitive exercise training in PAH; leaves open whether exercise hemodynamic stratification mitigates long-term RV remodeling risk.
The right ventricle (RV) is more sensitive to an increase in afterload than the left ventricle (LV), and RV afterload during exercise increases more easily than LV afterload. Pulmonary arterial hypertension (PAH)-specific therapy has improved pulmonary hemodynamics at rest; however, the pulmonary hemodynamic response to exercise is still abnormal in most patients with PAH. In these patients, RV afterload during exercise could be higher, resulting in a greater increase in RV wall stress. Recently, an increasing number of studies have indicated the short-term efficacy of exercise training. However, considering the potential risk of promoting myocardial maladaptive remodeling, even low-intensity repetitive exercise training could lead to long-term clinical deterioration. Further studies investigating the long-term effects on the RV and pulmonary vasculature are warranted. Although the indications for exercise training for patients with PAH have been expanding, exercise training may be associated with various risks. Training programs along with risk stratification based on the pulmonary hemodynamic response to exercise may enhance the safety of patients with PAH.
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Nishizaki et al. (2021) conducted a review in Pulmonary Arterial Hypertension. Exercise training was evaluated. Despite established short-term efficacy, repetitive exercise training in patients with pulmonary arterial hypertension may carry a risk of long-term myocardial maladaptive remodeling due to high residual right ventricular afterload.
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