Clinical usefulness of end-tidal CO2 profiles during incremental exercise in patients with chronic thromboembolic pulmonary hypertension

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dc.citation.volume120
dc.contributor.authorRamos, Roberta Pulcheri [UNIFESP]
dc.contributor.authorFerreira, Eloara Vieira Machado [UNIFESP]
dc.contributor.authorValois, Fabricio Martins [UNIFESP]
dc.contributor.authorCepeda, A. [UNIFESP]
dc.contributor.authorMessina, Carolina Montemor Soares [UNIFESP]
dc.contributor.authorOliveira, Rudolf Krawczenko Feitoza de [UNIFESP]
dc.contributor.authorAraujo, Andre Telis de Vilela [UNIFESP]
dc.contributor.authorTeles, Carlos Alberto [UNIFESP]
dc.contributor.authorNeder, Jose Alberto [UNIFESP]
dc.contributor.authorNery, Luiz Eduardo [UNIFESP]
dc.contributor.authorOta-Arakaki, Jaquelina Sonoe [UNIFESP]
dc.coverageLondon
dc.date.accessioned2020-07-31T12:47:26Z
dc.date.available2020-07-31T12:47:26Z
dc.date.issued2016
dc.description.abstractIntroduction: Great ventilation to carbon dioxide output (Delta(V)over dotE/Delta(V)over dotCO(2)) and reduced end-tidal partial pressures for CO2 (PETCO2) during incremental exercise are hallmarks of chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (IPAH). However, CTEPH is more likely to involve proximal arteries, which may lead to poorer right ventricle-pulmonary vascular coupling and worse gas exchange abnormalities. Therefore, abnormal PETCO2 profiles during exercise may be more prominent in patients with CTEPH and could be helpful to indicate disease severity. Methods: Seventy patients with CTEPH and 34 with IPAH underwent right heart catheterization and cardiopulmonary exercise testing. According to PETCO2 pattern during exercise, patients were classified as having an increase or stabilization in PETCO2 up to the gas exchange threshold (GET), an abrupt decrease in the rest-exercise transition or a progressive and slow decrease throughout exercise. A subgroup of patients with CTEPH underwent a constant work rate exercise test to obtain arterial blood samples during steady-state exercise. Results: Multivariate logistic regression analyses showed that progressive decreases in PETCO2 and SpO(2) were better discriminative parameters than Delta(V)over dotE/Delta(V)over dotCO(2) to distinguish CTEPH from IPAH. This pattern of PETCO2 was associated with worse functional impairment and greater reduction in PaCO2 during exercise. Conclusion: Compared to patients with IPAH, patients with CTEPH present more impaired gas exchange during exercise, and PETCO2 abnormalities may be used to identify more clinically and hemodynamically severe cases. (C) 2016 Elsevier Ltd. All rights reserved.en
dc.description.affiliationUniv Fed Sao Paulo UNIFESP, Dept Med, Div Resp Dis, Pulm Circulat Grp, Sao Paulo, SP, Brazil
dc.description.affiliationUniv Fed Sao Paulo UNIFESP, Dept Med, Div Resp Dis, Pulm Funct & Exercise Physiol Unit, Sao Paulo, SP, Brazil
dc.description.affiliationUnifespPulmonary Circulation Group, Division of Respiratory Diseases, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
dc.description.affiliationUnifespPulmonary Function and Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
dc.description.sponsorshipCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
dc.description.sponsorshipConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
dc.description.sponsorshipIDFAPESP: 007403/2011-19
dc.description.sponsorshipIDCNPq: 301475/2015-6
dc.format.extent70-77
dc.identifierhttp://dx.doi.org/10.1016/j.rmed.2016.09.020
dc.identifier.citationRespiratory Medicine. London, v. 120, p. 70-77, 2016.
dc.identifier.doi10.1016/j.rmed.2016.09.020
dc.identifier.issn0954-6111
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/56836
dc.identifier.wosWOS:000388116100010
dc.language.isoeng
dc.publisherW B Saunders Co Ltd
dc.relation.ispartofRespiratory Medicine
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectChronic thromboembolic pulmonary hypertensionen
dc.subjectExercise physiologyen
dc.subjectGas exchangeen
dc.titleClinical usefulness of end-tidal CO2 profiles during incremental exercise in patients with chronic thromboembolic pulmonary hypertensionen
dc.typeinfo:eu-repo/semantics/article
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