Background: Decreased exercise tolerance after pulmonary resection for lung cancer is strongly associated with a poor prognosis, but its determinants remain underexplored. We investigated the mechanisms of postoperative effort intolerance in lung cancer using combined exercise-stress echocardiography and cardiopulmonary exercise testing (ESE-CPET). Methods and Results: We prospectively analyzed 38 patients with suspected non-small cell lung cancer who underwent pulmonary resection. Preoperative and 6-month postoperative evaluations included resting echocardiography, ESE-CPET, and pulmonary function tests. Pulmonary vascular function was assessed using the mean pulmonary artery pressure/cardiac output (MPAP/CO) slope (n=38). Postoperative peak oxygen consumption (V̇O 2 ) significantly decreased (19.4 vs. 17.3 mL/min/kg, P2.0 predicted larger increases in peak SPAP following ≥3-segment resection (P=0.006), signifying increased pulmonary vascular stress. Conclusions: ESE-CPET demonstrated that extensive pulmonary resection adversely affects postoperative exercise tolerance and pulmonary vascular function, leading to greater ∆SPAP and steeper MPAP/CO slopes.
Tsuchiya et al. (2026) studied this question.