Factores determinantes de la respuesta al ejercicio en pacientes con hipertensión arterial pulmonar severa

Depto. de MedicinaFac. de MedicinaTRUEpu

Factors Affecting the Response to Exercise in Patients with Severe Pulmonary Arterial Hypertension

Introduction: Ergospirometry objectively quantifies exercise capacity. Up until now, the response to exercise evaluated by ergospirometry in patients with pulmonary arterial hypertension has only been described in recently diagnosed.patients. Our aim is to describe the response to exercise in patients with severe pulmonary arterial hypertension under specific treatment and define which parameters determine their exercise capacity. Patients and method: A cross-sectional study was performed on 80 patients, 57 women, aged 45 (14), with severe pulmonary arterial hypertension (48 idiopathic, 14 related to toxic rapeseed oil, 13 to connective tissue disease, 5 to human immunodeficiency virus), mean pulmonary pressure at diagnosis 61(15) mmHg and after 49(33) months under treatment since diagnosis. Biomarkers were measured and echocardiography and ergospirometry were performed the same day. Results: Our patients, under specific treatment, showed the typical behaviour of patients with pulmonary arterial hypertension with less limitation of both aerobic capacity and ventilatory efficiency. Being male (p=0.004), high ventilatory equivalent for carbon dioxide at anaerobic threshold (p<0.001) or biomarkers (p=0.006) were the strongest predictors of impaired peak oxygen uptake in multivariate analysis, whereas for an impaired percentage achieved of predicted value were right ventricle diastolic diameter (p<0.001), months of treatment (p=0.01) and high ventilatory equivalent for CO(2) (p<0.001). Conclusions: In pulmonary arterial hypertension, right ventricle dysfunction (expressed by its dilation or high NTproBNP) and impaired ventilatory inefficiency as well as being male or a short time under treatment can be considered as determining factors of impaired exercise capacity. (C) 2010 SEPAR. Published by Elsevier Espana, S.L. All rights reserved.0.372 SJR (2011) Q3, 67/126 Pulmonary and respiratory medicin

Predictive value of NT-proBNP combined with exercise capacity variables in pulmonary artery disease: insights from a Spanish cohort

Letter to the editor.4.638 JCR (2015) Q1, 24/124 Cardiac and cardiovascular systemsUE

Simplified risk stratification based on cardiopulmonary exercise test: A Spanish two‐center experience

Abstract A simplified 4‐strata risk stratification approach based on three variables is widespread in pulmonary arterial hypertension (PAH) at follow‐up. This study aimed to assess the impact of replacing the 6‐min walk test (6MWT) with the peak 02 uptake evaluated by the cardiopulmonary exercise test (CPET) on risk stratification by this scale. We included 180 prevalent patients with PAH from two reference hospitals in Spain, followed up between 2006 and 2022. Patients were included if all the variables of interest were available within a 3‐month period on the Spanish Registry of Pulmonary Arterial Hypertension (REHAP): functional class (FC); NT‐proBNP; 6MWT; and CPET. The original 4‐strata model (NT‐proBNP, 6MWT, FC) identified most patients at low or intermediate‐low risk (36.7% and 51.1%, respectively). Notably, the modified scale (NT‐proBNP, CPET, FC) improved the identification of patients at intermediate‐high risk up to 18.9%, and at high risk up to 1.1% in comparison with the previous 12.2% and 0.0% in the original scale. This new model increased the number of patients correctly classified into higher‐risk strata (positive NRI of 0.06), as well as classified more patients without events in lower‐risk strata (negative NRI of 0.04). The proposed score showed a slightly superior prognostic capacity compared with the original model (Harrel's C‐index 0.717 vs. 0.709). Using O2 uptake instead of distance walked in the 6MWT improves the identification of high‐risk patients using the 4‐strata scale. This change could have relevant prognostic implications and lead to changes in the specific treatment of PAH

Physical activity levels are low in patients with pulmonary hypertension

Pulmonary hypertension (PH) leads to exercise capacity impairment, but limited data are available on the objective evaluation of physical activity (PA) levels in these patients. Methods We assessed PA levels using triaxial accelerometry in Spanish PH patients (n=75, 48±14 years, 65% female) and gender/age matched controls (n=107), and examined potential associations of meeting minimum international recommendations [moderate-vigorous PA (MVPA) ≥150 min/week] with survival predictors. Results With the exception of vigorous PA (with very low values in both groups), all accelerometry data showed significant differences between patients and controls, with lower PA levels and proportion of individuals meeting minimum PA guidelines, but higher inactivity time, in the former. Notably, the odds ratio (OR) of having a “low-risk” value of 6-minute walking distance (≥464 m) or ventilatory equivalent for carbon dioxide (≤39) was higher in patients following MVPA guidelines than in their less active peers [OR =4.3, 95% confidence interval (CI), 1.6–11.6, P=0.005, and OR =4.5, 95% CI, 0.9–21.1, P=0.054]. Conclusions Daily PA is reduced in patients with PH, often to a level that may decrease their odds of survival. Efforts should be made to promote the implementation of healthy PA habits in this patient population.Sin financiación3.689 JCR (2018) Q2, 79/230 Oncology, 47/136 Medicine, Research & Experimental0.958 SJR (2018) Q1, 602/2844 Medicine (miscellaneous)No data IDR 2018UE

Effects of an 8-month exercise intervention on physical capacity, NT-proBNP, physical activity levels and quality of life data in patients with pulmonary arterial hypertension by NYHA class

This article provides descriptive detailed (pre and post) values of physical capacity variables, NT-proBNP, physical activity levels and quality of life in patients with pulmonary arterial hypertension (PH) (both, intervention and control group) by New York Heart Association (NYHA) class before and after an 8-month exercise intervention. The data are supplemental to our original Randomized Controlled Trial (RCT) entitled “Benefits of skeletal-muscle exercise training in pulmonary arterial hypertension: The WHOLEi+12 trial” (L. González-Saiz, C. Fiuza-Luces, F. Sanchis-Gomar, A. Santos-Lozano, C.A. Quezada-Loaiza, A. Flox-Camacho, D. Munguía-Izquierdo, I. Ara, A. Santalla, M. Morán, P. Sanz-Ayan, P. Escribano-Subías, A. Lucia A, 2017) .Sin financiaciónNo data JCR 20170.341 SJR (2017) Q1, 28/115 Multidisciplinary; Q2, 515/1261 EducationNo data IDR 2017UE

Rationale and design of a randomized controlled trial evaluating whole muscle exercise training effects in outpatients with pulmonary arterial hypertension (WHOLEi+12)

Physical exercise is an important component in the management of pulmonary artery hypertension (PAH). The aim of this randomized controlled trial (RCT) is to determine the effects of an 8-week intervention combining muscle resistance, aerobic and inspiratory pressure load exercises in PAH outpatients. The RCT will be conducted from September 2015 to September 2016 following the recommendations of the Consolidated Standards of Reported Trials (CONSORT), with a total sample size of n ≥ 48 (≥24 participants/group). We will determine the effects of the intervention on: (i) skeletal-muscle power and mass (primary end points); and (ii) NT-proBNP, cardiopulmonary exercise testing variables (VO2peak, ventilatory equivalent for CO2 at the anaerobic threshold (VE/VCO2 at the AT), end-tidal pressure of CO2 at the anaerobic threshold (PETCO2 at the AT), 6-min walking distance (6MWD), maximal inspiratory pressure (PImax), health-related quality of life (HRQoL), objectively-assessed spontaneous levels of physical activity, and safety (secondary end points). This trial will provide insight into biological mechanisms of the disease and indicate the potential benefits of exercise in PAH outpatients, particularly on muscle power.Fondo de Investigaciones Sanitarias (PS12/00194)3.189 (2015) Q2, 68/253 Pharmacology & pharmacy, 42/124 Cardiac & cardiovascular systemsUE