Supine exercise revealed abnormal haemodynamic responses, including increased pulmonary vascular resistance, in most COPD patients regardless of resting pulmonary hypertension status.
Observational (n=98)
What are the haemodynamic responses to exercise in COPD patients with and without pulmonary hypertension?
Exercise reveals abnormal physiological haemodynamic responses in the majority of COPD patients, even those without resting pulmonary hypertension.
The present study aimed to explore the prevalence of pre-capillary pulmonary hypertension (PH) and characterise haemodynamic vascular responses to physical exercise in chronic obstructive pulmonary disease (COPD) outpatients, where left ventricular dysfunction and comorbidities were excluded. 98 patients with COPD underwent right heart catheterisation at rest and during supine exercise. Mean pulmonary artery pressure (Ppa), pulmonary capillary wedge pressure (Ppcw) and cardiac output (CO) were measured at rest and during exercise. Exercise-induced increase in mean Ppa was interpreted relative to increase in blood flow, mean Ppa/CO, workload (W) and mean Ppa/W. Pulmonary vascular resistance (PVR) and pulmonary artery compliance (PAC) were calculated. PH at rest was defined as mean Ppa at rest ≥25 mmHg and Ppcw at rest <15 mmHg. Prevalence of PH was 5%, 27% and 53% in Global Initiative for Chronic Obstructive Lung Disease stages II, III and IV, respectively. The absolute exercise-induced rise in mean Ppa did not differ between subjects with and without PH. Patients without PH showed similar abnormal haemodynamic responses to exercise as the PH group, with increased PVR, reduced PAC and steeper slopes for mean Ppa/CO and mean Ppa/W. Exercise revealed abnormal physiological haemodynamic responses in the majority of the COPD patients. The future definition of PH on exercise in COPD should rely on the slope of mean Ppa related to cardiac output and workload rather than the absolute values of mean Ppa.
Hilde et al. (Thu,) conducted a observational in Chronic obstructive pulmonary disease (COPD) (n=98). Supine physical exercise vs. Rest was evaluated on Prevalence of pre-capillary pulmonary hypertension (PH) and haemodynamic vascular responses to physical exercise. Supine exercise revealed abnormal haemodynamic responses, including increased pulmonary vascular resistance, in most COPD patients regardless of resting pulmonary hypertension status.