The cardiopulmonary exercise test can be used as a noninvasive tool to evaluate hemodynamic burden in patients with pulmonary arterial hypertension (PAH), according to a new study published in Pulmonary Circulation

Patients with PAH may need to periodically undergo right heart catheterization to monitor their cardiac health, which can be challenging. 

Read more about the long-term monitoring of PAH


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Here, a team of researchers from Italy led by Piergiuseppe Agostoni, MD, PhD, evaluated the correlation between right heart catheterization and the cardiopulmonary exercise test to assess whether the latter could be used as a potential noninvasive tool to evaluate hemodynamic burden.

The study retrospectively enrolled 144 patients with PAH who had undergone a cardiopulmonary exercise test and right heart catheterization within 2 months. The researchers analyzed the cardiopulmonary exercise test in hemodynamic variable tertiles. They also evaluated the position of hemodynamic parameters in the peak end-tidal carbon dioxide pressure and compared this to a ventilation/carbon dioxide output slope scatterplot, which is a specific hallmark of respiratory abnormalities during exercise in patients with PAH. Finally, the researchers investigated the association between the cardiopulmonary exercise test and a hemodynamic burden score, which included mean pulmonary arterial pressure, pulmonary vascular resistance, cardiac index, and right atrial pressure.

The results showed that the ventilation/carbon dioxide output slope and the peak end-tidal carbon dioxide pressure significantly varied in the mean pulmonary arterial pressure and pulmonary vascular resistance tertiles. Peak oxygen uptake and oxygen pulse also varied in the tertiles of all hemodynamic parameters. 

The researchers found a significant correlation between estimated and calculated hemodynamic scores, with a precise match for patients with mild to moderate hemodynamic burden.

“Further investigation is needed to confirm and possibly strengthen our results in a larger prospective population,” the study authors wrote.

The cardiopulmonary exercise test is a specialized type of stress test or exercise test used to measure a person’s exercise ability. It is sometimes referred to as the oxygen consumption test.

Reference

Pezzuto B, Badagliacca R, Muratori M, et al. Role of cardiopulmonary exercise test in the prediction of hemodynamic impairment in patients with pulmonary arterial hypertension. Pulm Circ. Published online February 2, 2022. doi:10.1002/pul2.12044