Original Article
Factors Affecting the Response to Exercise in Patients with Severe Pulmonary Arterial Hypertension
Factores determinantes de la capacidad de ejercicio en pacientes con hipertensión arterial pulmonar severa
Ángela Flox-Camachoa,
, Pilar Escribano-Subíasa, Carmen Jiménez-López Guarcha, Almudena Fernández-Vaquerob, Dolores Martín-Ríosc, Carlos Sáenz de la Calzada-Campoa
Corresponding author
a Servicio de Cardiología, Unidad de Insuficiencia Cardíaca, Hipertensión Pulmonar y Trasplante Cardíaco, H.U. 12 de Octubre, Red de Investigación Cooperativa (REDINSCOR) del Ministerio de Sanidad y Consumo de España, Madrid, Spain
b Dpto. de CC Biomédicas Básicas, Universidad Europea de Madrid, Madrid, Spain
c Servicio de Medicina Preventiva, Hospital Fundación de Alcorcón, Madrid, Spain
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"entidad" => "Servicio de Medicina Preventiva, Hospital Fundación de Alcorcón, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores determinantes de la capacidad de ejercicio en pacientes con hipertensión arterial pulmonar severa" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-05-28" "fechaAceptado" => "2010-07-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec156145" "palabras" => array:4 [ 0 => "Pulmonary arterial hypertension" 1 => "Ergospirometry" 2 => "Echocardiography" 3 => "Natriuretic peptides" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec156146" "palabras" => array:4 [ 0 => "Hipertensión arterial pulmonar" 1 => "Ergoespirometría" 2 => "Ecocardiografía" 3 => "Péptidos natriuréticos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We aimed to describe the response to exercise of patients with severe pulmonary arterial hypertension under specific treatment and define which parameters determine their exercise capacity.</p> <span class="elsevierStyleSectionTitle">Patients and method</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ours was a cross-sectional study including 80 patients, of whom 57 were women, with a mean age of 44 (13), with severe pulmonary arterial hypertension (48 idiopathic, 14 rapeseed oil poisoning, 13 collagenosis, 5 human immunodeficiency virus). Mean pulmonary pressure at diagnosis was 61(15) mmHg and patients had received 49(33) months of treatment since diagnosis. NTproBNP was determined and echocardiography and ergospirometry were performed.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Our patients, who were receiving specific treatment, presented typical behavior of patients with pulmonary arterial hypertension on ergospirometry, although with less limitation in aerobic capacity and ventilatory efficiency. Being male (p = 0.004), presenting high ventilatory equivalent for carbon dioxide at the anaerobic threshold (p<0.001) and NTproBNP (p = 0.006) were all associated in the multivariate analysis with poorer peak oxygen uptake. Meanwhile, less time under treatment (p = 0.01), right ventricle dilatation (p<0.001) and high ventilatory equivalent for carbon dioxide at the anaerobic threshold (p<0.001) were associated with poorer percentage of predicted values.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In pulmonary arterial hypertension, right ventricle dysfunction (RV dilatation and high NTproBNP), ventilatory inefficiency, being male and recent diagnosis (implying less time receiving treatment) can be considered predictors for impaired functional capacity.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La ergoespirometría cuantifica objetivamente la capacidad de ejercicio. Hasta ahora, solo se ha descrito el comportamiento al ejercicio mediante ergoespirometría en la hipertensión arterial pulmonar en pacientes recién diagnosticados.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El objetivo fue describir el comportamiento al ejercicio de pacientes con hipertensión arterial pulmonar severa bajo tratamiento y definir que parámetros lo determinan.</p> <span class="elsevierStyleSectionTitle">Pacientes y método</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal realizado en 80 pacientes, 57 mujeres, 44 (13) años, con hipertensión arterial pulmonar severa (48 idiopática, 14 aceite colza, 13 colagenosis, 5 virus del sida), presión pulmonar media al diagnóstico 61 (15) mmHg y 49 (33) meses bajo tratamiento, en los que se determinó NTproBNP y realizó ecocardiograma y ergoespirometría.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Nuestros pacientes, bajo tratamiento específico, presentaron el comportamiento típico de los pacientes con hipertensión arterial pulmonar en la ergoespirometría, aunque con menor limitación de capacidad aeróbica y de eficiencia ventilatoria. Ser varón (p = 0,004), presentar elevados equivalente ventilatorio de dióxido de carbono en el umbral anaeróbico (p < 0,001) y NTproBNP (p = 0,006) se asociaron al análisis multivariado con peor consumo de oxígeno en el máximo esfuerzo mientras que con peores cifras del valor porcentual respecto al predicho lo hicieron: menos tiempo de tratamiento (p = 0,01), la dilatación del ventrículo derecho (p < 0,001) y un elevado equivalente ventilatorio de dióxido de carbono en el umbral anaeróbico (p < 0,001).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">En la hipertensión arterial pulmonar, se pueden considerar predictores de peor capacidad funcional la disfunción ventricular derecha (dilatación del VD y elevación de NTproBNP), la ineficiencia ventilatoria, el sexo masculino y el reciente diagnóstico, que implica menor tiempo bajo tratamiento.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 2 | 9 |
| 2024 October | 25 | 15 | 40 |
| 2024 September | 30 | 18 | 48 |
| 2024 August | 44 | 37 | 81 |
| 2024 July | 27 | 24 | 51 |
| 2024 June | 32 | 20 | 52 |
| 2024 May | 43 | 27 | 70 |
| 2024 April | 20 | 23 | 43 |
| 2024 March | 19 | 14 | 33 |
| 2024 February | 15 | 16 | 31 |
| 2023 March | 5 | 2 | 7 |
| 2023 February | 15 | 14 | 29 |
| 2023 January | 18 | 25 | 43 |
| 2022 December | 20 | 24 | 44 |
| 2022 November | 21 | 24 | 45 |
| 2022 October | 21 | 27 | 48 |
| 2022 September | 13 | 27 | 40 |
| 2022 August | 22 | 32 | 54 |
| 2022 July | 18 | 50 | 68 |
| 2022 June | 11 | 24 | 35 |
| 2022 May | 16 | 29 | 45 |
| 2022 April | 20 | 26 | 46 |
| 2022 March | 13 | 39 | 52 |
| 2022 February | 21 | 30 | 51 |
| 2022 January | 15 | 41 | 56 |
| 2021 December | 17 | 44 | 61 |
| 2021 November | 18 | 58 | 76 |
| 2021 October | 31 | 70 | 101 |
| 2021 September | 24 | 61 | 85 |
| 2021 August | 12 | 33 | 45 |
| 2021 July | 18 | 27 | 45 |
| 2021 June | 17 | 34 | 51 |
| 2021 May | 15 | 21 | 36 |
| 2021 April | 51 | 76 | 127 |
| 2021 March | 18 | 19 | 37 |
| 2021 February | 13 | 22 | 35 |
| 2021 January | 8 | 15 | 23 |
| 2020 December | 13 | 22 | 35 |
| 2020 November | 7 | 10 | 17 |
| 2020 October | 5 | 8 | 13 |
| 2020 September | 9 | 4 | 13 |
| 2020 August | 11 | 16 | 27 |
| 2020 July | 16 | 13 | 29 |
| 2020 June | 5 | 1 | 6 |
| 2020 May | 14 | 17 | 31 |
| 2020 April | 13 | 14 | 27 |
| 2020 March | 13 | 15 | 28 |
| 2020 February | 11 | 17 | 28 |
| 2020 January | 12 | 17 | 29 |
| 2019 December | 18 | 20 | 38 |
| 2019 November | 10 | 10 | 20 |
| 2019 October | 7 | 14 | 21 |
| 2019 September | 10 | 15 | 25 |
| 2019 August | 9 | 11 | 20 |
| 2019 July | 8 | 17 | 25 |
| 2019 June | 6 | 6 | 12 |
| 2019 May | 11 | 22 | 33 |
| 2019 April | 14 | 16 | 30 |
| 2019 March | 14 | 26 | 40 |
| 2019 February | 10 | 10 | 20 |
| 2019 January | 9 | 17 | 26 |
| 2018 December | 6 | 11 | 17 |
| 2018 November | 15 | 12 | 27 |
| 2018 October | 32 | 14 | 46 |
| 2018 September | 8 | 9 | 17 |
| 2018 May | 6 | 0 | 6 |
| 2018 April | 9 | 7 | 16 |
| 2018 March | 1 | 3 | 4 |
| 2018 February | 5 | 6 | 11 |
| 2018 January | 7 | 15 | 22 |
| 2017 December | 7 | 9 | 16 |
| 2017 November | 6 | 6 | 12 |
| 2017 October | 8 | 11 | 19 |
| 2017 September | 5 | 13 | 18 |
| 2017 August | 6 | 13 | 19 |
| 2017 July | 1 | 3 | 4 |
| 2017 June | 8 | 10 | 18 |
| 2017 May | 7 | 10 | 17 |
| 2017 April | 6 | 5 | 11 |
| 2017 March | 2 | 20 | 22 |
| 2017 February | 1 | 2 | 3 |
| 2017 January | 3 | 6 | 9 |
| 2016 December | 9 | 10 | 19 |
| 2016 November | 13 | 12 | 25 |
| 2016 October | 8 | 11 | 19 |
| 2016 September | 17 | 10 | 27 |
| 2016 August | 9 | 8 | 17 |
| 2016 July | 1 | 5 | 6 |
| 2016 May | 1 | 4 | 5 |
| 2016 April | 1 | 1 | 2 |
| 2016 March | 8 | 0 | 8 |
| 2016 February | 5 | 0 | 5 |
| 2016 January | 7 | 0 | 7 |
| 2015 December | 4 | 0 | 4 |
| 2015 October | 41 | 26 | 67 |
| 2015 September | 35 | 10 | 45 |
| 2015 August | 29 | 12 | 41 |
| 2015 July | 40 | 16 | 56 |
| 2015 June | 28 | 23 | 51 |
| 2015 May | 50 | 14 | 64 |
| 2015 April | 42 | 19 | 61 |
| 2015 March | 27 | 13 | 40 |
| 2015 February | 31 | 19 | 50 |
| 2015 January | 30 | 22 | 52 |
| 2014 December | 33 | 8 | 41 |
| 2014 November | 31 | 15 | 46 |
| 2014 October | 41 | 13 | 54 |
| 2014 September | 29 | 10 | 39 |
| 2014 August | 36 | 19 | 55 |
| 2014 July | 42 | 11 | 53 |
| 2014 June | 47 | 17 | 64 |
| 2014 May | 58 | 12 | 70 |
| 2014 April | 45 | 9 | 54 |
| 2014 March | 61 | 19 | 80 |
| 2014 February | 43 | 10 | 53 |
| 2014 January | 51 | 13 | 64 |
| 2013 December | 49 | 16 | 65 |
| 2013 November | 74 | 12 | 86 |
| 2013 October | 46 | 10 | 56 |
| 2013 September | 44 | 11 | 55 |
| 2013 August | 57 | 16 | 73 |
| 2013 July | 81 | 15 | 96 |
| 2013 June | 53 | 10 | 63 |
| 2013 May | 36 | 3 | 39 |
| 2013 April | 24 | 5 | 29 |
| 2013 March | 8 | 2 | 10 |
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