Persistent exercise limitation after successful pulmonary endoarterectomy: Frequency and determinants 11 Medical and Health Sciences 1102 Cardiorespiratory Medicine and Haematology

Angelo G. Corsico, Andrea M. D'Armini, Valentina Conio, Antonio Sciortino, Maurizio Pin, Valentina Grazioli, Giulia Di Vincenzo, Rita Di Domenica, Anna Celentano, Benedetta Vanini, Amelia Grosso, Erica Gini, Federica Albicini, Vera N. Merli, Vanessa Ronzoni, Stefano Ghio, Catherine Klersy, Isa Cerveri

Research output: Contribution to journalArticlepeer-review

Abstract

Background: After 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. Methods: Out 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. Results: Eighty 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, FEV 1 , FEV 1 /VC, D LCO , HbSaO 2 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. Conclusions: After 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.

Original languageEnglish
Article number34
JournalRespiratory Research
Volume20
Issue number1
DOIs
Publication statusPublished - Feb 14 2019

Keywords

  • Embolism
  • Hypertension
  • Physical exertion
  • pulmonary
  • Surgical procedures

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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