Background: Patients with chronic thromboembolic pulmonary disease without pulmonary hypertension at rest (CTEPD) may suffer from exercise intolerance. An important research question is therefore if this is due to abnormal hemodynamic responses in the pulmonary circulation during exercise.

Aims: To characterize pulmonary hemodynamics by exercise in patients with CTEPD by right heart catheterization and contribute to the definition of CTEPD helping to identify the main cause of exercise limitation.

Methods: 23 symptomatic patients with persistent perfusion defects on V/Q scan all diagnosed after pulmonary embolism (PE) underwent exercise right heart catheterization. The diagnosis of chronic thromboembolic pulmonary disease (CTEPD) was defined by the abscence of resting PH (mPAP >20 mmHg) proposed at the 6th World Symposium on Pulmonary Hypertension. Exercise induced pulmonary hypertension (EIPH) was defined by combining mPAP >30 mmHg and TPR >3 WU

Results: Six patients was diagnosed with PH. 17 with CTEPD. Four patients with CTEPD met the criteria for EIPH, and three CTEPD patients had borderline EIPH (mPAP ranging from 27-31 mmHg, TPR ranging from 2,5-3,0 WU). One CTEPD patient was unable to perform exercise right heart catheterization due to leg cramps.

Conclusion(s): Up till now, four out of seventeen patients with CTEPD have met the criteria for EIPH, demonstrating latent abnormal pulmonary vascular responses in nearly a quarter of patients with CTEPD. However, it is too early to draw any conclusion about the incidence of EIPH among CTED patients in this ongoing study.

Table

Baseline characteristics and right heart catheterization parameters of patients with CTEPD

Image

Study outline

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/pulmonary-hemodynamics-at-rest-and-during-exercise-in-patients-with-chronic-thromboembolic-pulmonary-disease/