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Exercise induced pulmonary hypertension

Wook-Jin Chung
Pulmonary arterial hypertension (PAH) is a life-threatening disorder with a poor prognosis and causes pulmonary vascular remodeling accompanied with increased pulmonary arterial medial wall thickness and fibrosis, which leads to vascular and right ventricular (RV) dysfunction. Despite treatment with prostacyclin, endothelin antagonist, and phosphodiesterase-5 inhibitors the 1-year mortality rate of PAH still remains high. Recent registries, clinical trials, and basic researches have been increasing the knowledge of PAH and it would contribute to potential therapeutic strategies and better clinical outcome...
September 2016: Journal of Hypertension
Masaru Obokata, Yasufumi Nagata, Yuichiro Kado, Masahiko Kurabayashi, Yutaka Otsuji, Masaaki Takeuchi
BACKGROUND: Exercise-induced pulmonary hypertension (EIPH) may develop even at low workloads in heart failure (HF) patients. Ventricular-arterial stiffening plays an important role in the pathophysiology of HF with preserved ejection fraction (HFpEF). This study aimed to compare the response of ventricular-arterial coupling and PH during low-level exercise between HFpEF and HF with reduced EF (HFrEF). METHODS AND RESULTS: Echocardiography was performed at rest and during 10 W of bicycle exercise in HFpEF (n=37) and HFrEF (n=43)...
October 10, 2016: Journal of Cardiac Failure
Michele D'Alto, Adriana Pavelescu, Paola Argiento, Emanuele Romeo, Anna Correra, Giovanni Maria Di Marco, Antonello D'Andrea, Berardo Sarubbi, Maria Giovanna Russo, Robert Naeije
BACKGROUND: Exercise-induced increase in pulmonary artery systolic pressure (PASP) as a possible measure of right ventricular (RV) contractile reserve has been shown to predict survival in severe pulmonary hypertension. However, RV contractile reserve can also be measured by changes in stroke volume (SV), tricuspid annular plane systolic excursion (TAPSE), or tricuspid annular systolic velocity (S'). The limits of normal values and the functional significance of these changes in healthy subjects are not well known...
October 2, 2016: Echocardiography
A Young Lim, Chunghun Kim, Sung-Ji Park, Jin-Oh Choi, Sang-Chol Lee, Seung Woo Park
AIMS: Recent studies have shown that exercise-induced pulmonary hypertension (EIPH) is not rare in patients with preserved left ventricular ejection fraction (LVEF). However, the determinants and clinical implication of EIPH in these patients are unclear. METHODS AND RESULTS: This study included 1383 patients who were referred for exercise echocardiography to evaluate unexplained exertional dyspnoea or chest discomfort. Pulmonary artery systolic pressure (PASP) was estimated from the maximal velocity of the tricuspid regurgitant jet added to a right atrial pressure of 10 mmHg...
September 27, 2016: European Heart Journal Cardiovascular Imaging
Wook-Jin Chung
Pulmonary arterial hypertension (PAH) is a life-threatening disorder with a poor prognosis and causes pulmonary vascular remodeling accompanied with increased pulmonary arterial medial wall thickness and fibrosis, which leads to vascular and right ventricular (RV) dysfunction. Despite treatment with prostacyclin, endothelin antagonist, and phosphodiesterase-5 inhibitors the 1-year mortality rate of PAH still remains high. Recent registries, clinical trials, and basic researches have been increasing the knowledge of PAH and it would contribute to potential therapeutic strategies and better clinical outcome...
September 2016: Journal of Hypertension
Michael R Pinsky
The primary role of the right ventricle (RV) is to deliver all the blood it receives per beat into the pulmonary circulation without causing right atrial pressure to rise. To the extent that it also does not impede left ventricular (LV) filling, cardiac output responsiveness to increased metabolic demand is optimized. Since cardiac output is a function of metabolic demand of the body, during stress and exercise states the flow to the RV can vary widely. Also, instantaneous venous return varies widely for a constant cardiac output as ventilatory efforts alter the dynamic pressure gradient for venous return...
September 10, 2016: Critical Care: the Official Journal of the Critical Care Forum
Guido Claessen, Andre La Gerche, Thibault Petit, Hilde Gillijns, Jan Bogaert, Mathias Claeys, Steven Dymarkowski, Piet Claus, Marion Delcroix, Hein Heidbuchel
BACKGROUND: Non-invasive estimates have suggested that asymptomatic BMPR2 mutation carriers may have an abnormal pulmonary vascular response to exercise and hypoxia. However, this has not been assessed with "gold standard" invasive measures. METHODS: Eight controls and 8 asymptomatic BMPR2 mutation carriers underwent cardiac magnetic resonance imaging with simultaneous invasive pressure recording during bicycle exercise in normoxia, hypoxia and after sildenafil administration...
June 24, 2016: Journal of Heart and Lung Transplantation
Linda Vignozzi, Annamaria Morelli, Ilaria Cellai, Sandra Filippi, Paolo Comeglio, Erica Sarchielli, Elena Maneschi, Gabriella Barbara Vannelli, Luciano Adorini, Mario Maggi
Farnesoid X receptor (FXR) activation by obeticholic acid (OCA) has been demonstrated to inhibit inflammation and fibrosis development and even induce fibrosis regression in liver, kidney and intestine in multiple disease models. OCA also inhibits liver fibrosis in nonalcoholic steatohepatitis patients. FXR activation has also been demonstrated to suppress the inflammatory response and to promote lung repair after lung injury. This study investigated the effects of OCA treatment (3, 10 or 30mg/kg, daily for 5days a week, for 7 and/or 28 days) on inflammation, tissue remodeling and fibrosis in the monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH) rat model...
July 14, 2016: Journal of Steroid Biochemistry and Molecular Biology
Roy L Sutliff
In this issue of Acta Physiologica Scandinavica Li et al, make important contributions to the field of pulmonary hypertension by advancing our understanding of the molecular mechanisms that drive hypoxia-induced proliferation of adventitial fibroblasts PAFs (REF). Pulmonary hypertension (PH) is defined as an elevation of mean pulmonary artery pressure above 25 mm Hg at rest or above 30 mm Hg with exercise and is characterized by a narrowing of the pulmonary vasculature (Barst, 2008, Rabinovitch, 2012). The increase in pulmonary vascular resistance and pressure increases right ventricular afterload and the pressure required to force blood through the narrowed pulmonary vascular bed...
July 15, 2016: Acta Physiologica
D Kylhammar, G Rådegran
Hypoxic pulmonary vasoconstriction (HPV) serves to optimize ventilation-perfusion matching in focal hypoxia and thereby enhances pulmonary gas exchange. During global hypoxia, however, HPV induces general pulmonary vasoconstriction, which may lead to pulmonary hypertension (PH), impaired exercise capacity, right-heart failure and pulmonary oedema at high altitude. In chronic hypoxia, generalized HPV together with hypoxic pulmonary arterial remodelling, contribute to the development of PH. The present article reviews the principal pathways in the in vivo modulation of HPV, hypoxic pulmonary arterial remodelling and PH with primary focus on the endothelin-1, nitric oxide, cyclooxygenase and adenine nucleotide pathways...
July 6, 2016: Acta Physiologica
Manuel Jonas Richter, Katrin Milger, Khodr Tello, Philipp Stille, Werner Seeger, Eckhard Mayer, Hossein A Ghofrani, Henning Gall
BACKGROUND: Six-minute walk test (6MWT) is routinely performed in chronic thromboembolic pulmonary hypertension (CTEPH) before pulmonary endarterectomy (PEA). However, the clinical relevance of heart rate response (ΔHR) and exercise-induced oxygen desaturation (EID) during 6MWT is remaining unknown. METHODS: Patients undergoing PEA in our center between 03/2013-04/2014 were assessed prospectively with hemodynamic and exercise parameters prior to and 1 year post-PEA...
2016: BMC Pulmonary Medicine
Coen van Kan, Mart N van der Plas, Herre J Reesink, Reindert P van Steenwijk, Jaap J Kloek, Robert Tepaske, Peter I Bonta, Paul Bresser
BACKGROUND: Patients with chronic thromboembolic disease (CTED) may suffer from exercise intolerance without pulmonary hypertension at rest. Pulmonary endarterectomy (PEA) for symptomatic CTED results in improvement of symptoms and quality of life. Neither the pathophysiology of the exercise limitation nor the underlying mechanisms of the PEA-induced improvement have been studied previously. OBJECTIVES: We studied hemodynamic and ventilatory responses upon exercise in 14 patients with CTED...
September 2016: Journal of Thoracic and Cardiovascular Surgery
Rui Baptista, Sara Serra, Rui Martins, Rogério Teixeira, Graça Castro, Maria João Salvador, José António Pereira da Silva, Lèlita Santos, Pedro Monteiro, Mariano Pêgo
BACKGROUND: Pulmonary arterial hypertension (PAH) complicates the course of systemic sclerosis (SSc) and is associated with poor prognosis. The elevation of systolic pulmonary arterial pressure (sPAP) during exercise in patients with SSc with normal resting haemodynamics may anticipate the development of PAH. Exercise echocardiography (ExEcho) has been proposed as a useful technique to identify exercise-induced increases in sPAP, but it is unclear how to clinically interpret these findings...
2016: Arthritis Research & Therapy
Rafael Colombo, Rafaela Siqueira, Adriana Conzatti, Bruna Gazzi de Lima, Tânia Regina Gattelli Fernandes, Alessandra Eifler Guerra Godoy, Isnard Elman Litvin, Jairo Montemor Augusto Silva, Paulo José Ferreira Tucci, Alex Sander da Rosa Araújo, Adriane Belló-Klein
No abstract text is available yet for this article.
June 27, 2016: Vascular Pharmacology
Francesco Bandera, Greta Generati, Marta Pellegrino, Andrea Garatti, Valentina Labate, Eleonora Alfonzetti, Maddalena Gaeta, Serenella Castelvecchio, Lorenzo Menicanti, Marco Guazzi
AIMS: In heart failure patients with reduced ejection fraction (HFrEF), exercise-induced functional mitral regurgitation (MR) may affect functional capacity and outcome. We sought to study functional and cardiac phenotypes of HFrEF patients according to the MR degree. METHODS AND RESULTS: We performed rest and exercise echocardiography (Ex-Echo), simultaneously combined with cardiopulmonary exercise test (CPET), in 102 HFrEF patients, identifying 3 groups: non-severe (ERO <20 mm(2)) MR (group A), exercise-induced severe (ERO ≥20 mm(2)) MR (group B), and rest severe MR (group C)...
May 18, 2016: European Heart Journal Cardiovascular Imaging
J Sawalla Guseh
Normal pulmonary artery pressures at rest, with an exaggerated rise during exercise, characterize exercise-induced pulmonary hypertension. Exercise itself as it relates to this condition is not deleterious, nor does it cause or induce disease. However much like any classical stress test, it is a physiologic probe that aids in disease unmasking. Although more work is required to establish criteria for defining this clinical entity, the phenomenon is real. It remains unknown whether it represents a nascent form of cardiopulmonary disease and whether its genesis predicts fulminant cardiopulmonary disease...
June 2016: Current Treatment Options in Cardiovascular Medicine
Mi-Hyang Jung, Hae Ok Jung, Mi-Jeong Kim, Jung-Won Lee, Ho-Joong Youn
AIMS: We aimed to evaluate whether prolapsing leaflet-specific exercise pulmonary hypertension (PHT) exists and to identify the related mechanisms. METHODS AND RESULTS: Resting and bicycle exercise transthoracic echocardiography was performed in 35 consecutive patients (aged 56 ± 11, 69% men) with asymptomatic, moderate-to-severe, and degenerative mitral regurgitation (MR). The patients were classified into two groups according to the prolapsing leaflet: an anterior mitral leaflet (AML) group (n = 17) and a posterior mitral leaflet (PML) group (n = 18)...
May 8, 2016: European Heart Journal Cardiovascular Imaging
Olivier Sitbon, Caroline Sattler, Laurent Bertoletti, Laurent Savale, Vincent Cottin, Xavier Jaïs, Pascal De Groote, Ari Chaouat, Céline Chabannes, Emmanuel Bergot, Hélène Bouvaist, Claire Dauphin, Arnaud Bourdin, Fabrice Bauer, David Montani, Marc Humbert, Gérald Simonneau
Treatment for pulmonary arterial hypertension (PAH) has been underpinned by single-agent therapy to which concomitant drugs are added sequentially when pre-defined treatment goals are not met.This retrospective analysis of real-world clinical data in 97 patients with newly diagnosed PAH (86% in New York Heart Association functional class III-IV) explored initial dual oral combination treatment with bosentan plus sildenafil (n=61), bosentan plus tadalafil (n=17), ambrisentan plus tadalafil (n=11) or ambrisentan plus sildenafil (n=8)...
June 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Damien Voilliot, Julien Magne, Raluca Dulgheru, Seisyou Kou, Christine Henri, Luis Caballero, Carla De Sousa, Muriel Sprynger, Béatrice Andre, Luc A Pierard, Patrizio Lancellotti
BACKGROUND: Early detection of pulmonary arterial hypertension (PH) is crucial in systemic scleroderma. However, predictors of new onset of resting PH during follow-up (FUPH) have been poorly explored. AIM: To determine whether nailfold videocapillaroscopy (NVC) grade and exercise echocardiographic variables are predictors of FUPH. METHODS: We prospectively enrolled 40 patients with systemic sclerosis (age 54±13 years; 68% women). All patients underwent graded semisupine exercise echocardiography and NVC...
April 2016: Archives of Cardiovascular Diseases
J Novo Matos, A Malbon, M Dennler, T Glaus
BACKGROUND: In both humans and dogs the pulmonary vasculature is able to recruit large-diameter anatomical intrapulmonary arteriovenous anastomoses (IPAVAs). In healthy people the opening of these anastomoses affects the degree of exercise-induced increase in pulmonary arterial pressure. The presence of these IPAVAs can be demonstrated using saline contrast echocardiography. OBJECTIVES: The aims of the present study were to characterize severely affected, naturally infected dogs with Angiostrongylus vasorum, to evaluate if these dogs can open IPAVAs, and to assess if the recruitment of such anastomoses affects the severity of pulmonary hypertension (PH)...
June 2016: Journal of Veterinary Cardiology: the Official Journal of the European Society of Veterinary Cardiology
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