ISSN: 1885-5857 Impact factor 2023 7.2
Vol. 77. Num. 2.
Pages 158-166 (February 2024)

Original article
Value of exercise right heart catheterization in the differential diagnosis of chronic thromboembolic pulmonary disease

Impacto del cateterismo derecho de ejercicio en el diagnóstico diferencial de la enfermedad tromboembólica pulmonar crónica

Sergio Huertas NietoabcMaite Velázquez MartínabcdeFernando Sarnago CebadaabcCarmen Jiménez López-GuarchacdeNicolás Maneiro MelónabcÁngela Flox CamachoacTeresa Segura de la CalacAlejandro Cruz UtrillaacRicardo Aguilar ColindrescMaría Jesús López GudeacfCarlos Andrés Quezada LoaizaacghYolanda Revilla OstolazaaceiSergio Alonso CharterinaaciCovadonga Gómez CuervojFernando Arribas YnsaurriagaabcdePilar Escribano Subíasacde
Imagen extra
Rev Esp Cardiol. 2024;77:158-66
Abstract
Introduction and objectives

Chronic thromboembolic disease refers to the presence of chronic thrombotic pulmonary vascular thrombosis without pulmonary hypertension (PH) at rest but with exercise limitation after pulmonary embolism (PE). Our aim was to evaluate the hemodynamic response to exercise in these patients and its correlation with the values reached in cardiopulmonary exercise testing.

Methods

We included symptomatic patients with persistent pulmonary thrombosis after PE. We excluded patients with left heart disease or significant PH (mean pulmonary arterial pressure [mPAP] >25mmHg, pulmonary vascular resistance >3 WU, and pulmonary capillary wedge pressure [PCWP] >15mmHg). Cardiopulmonary exercise testing and exercise right heart catheterization were performed. Exercise-induced precapillary PH was defined as mPAP/CO slope >3 and PCWP/CO slope <2mmHg/l/min. The hemodynamic response and the values obtained in cardiopulmonary exercise testing were compared between patients with and without exercise-induced precapillary PH.

Results

We studied 36 patients; 4 were excluded due to incomplete hemodynamic data. Out of the 32 patients analyzed; 3 developed a pathological increase in PCWP. Among the remaining 29 patients (mean age, 49.4±13.7 years, 34.5% women), 13 showed exercise-induced PH. Resting mPAP was higher in those who developed exercise-induced PH (23.3±5.4 vs 19.0±3.8mmHg; P=.012), although CO was similar in the 2 groups. Patients with exercise-induced PH exhibited data of ventilatory inefficiency with reduced values of end-tidal CO2 pressure at the anaerobic threshold (32.8±3.0 vs 36.2±3.3mmHg; P=.021) and a higher Ve/VCO2 slope (34.2±4.8 vs 30.7±5.0; P=.049).

Conclusions

Exercise limitation and ventilatory inefficiency could be attributable to exercise-induced precapillary PH in a subgroup of patients with persistent pulmonary thrombosis and dyspnea.

Keywords

Chronic thromboembolic pulmonary disease
Swan-Ganz catheterization
Exercise
Pulmonary hypertension
Cardiopulmonary exercise testing

Identify yourself

Not yet a subscriber to the journal?

Purchase access to the article

By purchasing the article, the PDF of the same can be downloaded

Price: 19,34 €

Phone for incidents

Monday to Friday from 9am to 6pm (GMT+1) except for the months of July and August, which will be from 9am to 3pm

Calls from Spain 932 415 960
Calls from outside Spain +34 932 415 960
Copyright © 2023. Sociedad Española de Cardiología
Are you a healthcare professional authorized to prescribe or dispense medications?