心肺运动试验在肺动脉高压中的应用
|
摘要
心肺运动试验可在运动状态下客观、准确、定量、整体地评估肺动脉高压患者的心脏和肺循环功能状态,从而在评价肺动脉高压严重程度、治疗效果以及预后方面显示出很好的优越性。目前心肺运动试验在国内开展较少,现就心肺运动试验的主要指标在肺动脉高压中的意义做一综述。
Cardiopulmonary exercise testing(CPET) can objectively,accurately,quantitatively and integrally evaluate the functions of the heart and lung in patients with pulmonary hypertension.Therefore it shows excellent superiority in assessing disease severity,therapeutic responses and prognosis.Few hospitals in China can carry out this test.In this paper we review the significance of main parameters of CPET in pulmonary hypertension
Cardiopulmonary exercise testing(CPET) can objectively,accurately,quantitatively and integrally evaluate the functions of the heart and lung in patients with pulmonary hypertension.Therefore it shows excellent superiority in assessing disease severity,therapeutic responses and prognosis.Few hospitals in China can carry out this test.In this paper we review the significance of main parameters of CPET in pulmonary hypertension
引文
[1]Galie N,Humbert M,Vachiery JL,et al.2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension:The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology(ESC)and the European Respiratory Society(ERS):Endorsed by:Association for European Paediatric and Congenital Cardiology(AEPC),International Society for Heart and Lung Transplantation(ISHLT)[J].Eur Heart J,2016,37(1):67-119.
[2]Pinkstaff SO,Burger CD,Daugherty J,et al.Cardiopulmonary exercise testing in patients with pulmonary hypertension:clinical recommendations based on a review of the evidence[J].Expert Rev Respir Med,2016,10(3):279-295.
[3]Guazzi M,Adams V,Conraads V,et al.EACPR/AHA Joint Scientific Statement.Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations[J].Eur Heart J,2012,33(23):2917-2927.
[4]Guazzi M,Arena R,Halle M,et al.2016 Focused Update:Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations[J].Circulation,2016,133(24):e694-e711.
[5]文富强,袁玉茹,梁斌苗,等.心肺运动试验的原理及其解读——病理生理及临床应用[M].北京:科学出版社,2008:197-198.
[6]Mancini DM,Eisen H,Kussmaul W,et al.Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure[J].Circulation,1991,83(3):778-786.
[7]Sun XG,Hansen JE,Oudiz RJ,et al.Exercise pathophysiology in patients with primary pulmonary hypertension[J].Circulation,2001,104(4):429-435.
[8]Liu WH,Luo Q,Liu ZH,et al.Differences in exercise capacity in patients with chronic left heart failure and chronic right heart failure[J].Heart Lung Circ,2014,23(11):1036-1040.
[9]Liu WH,Luo Q,Liu ZH,et al.Differences in pulmonary function and exercise capacity in patients with idiopathic dilated cardiomyopathy and idiopathic pulmonary arterial hypertension[J].Heart Lung,2014,43(4):317-321.
[10]Wensel R,Opitz CF,Anker SD,et al.Assessment of survival in patients with primary pulmonary hypertension:importance of cardiopulmonary exercise testing[J].Circulation,2002,106(3):319-324.
[11]Wensel R,Francis DP,Meyer FJ,et al.Incremental prognostic value of cardiopulmonary exercise testing and resting haemodynamics in pulmonary arterial hypertension[J].Int J Cardiol,2013,167(4):1193-1198.
[12]Gitt AK,Wasserman K,Kilkowski C,et al.Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death[J].Circulation,2002,106(24):3079-3084.
[13]Deboeck G,Scoditti C,Huez S,et al.Exercise testing to predict outcome in idiopathic versus associated pulmonary arterial hypertension[J].Eur Respir J,2012,40(6):1410-1419.
[14]Ferreira EV,Ota-Arakaki JS,Ramos RP,et al.Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension[J].Eur J Prev Cardiol,2014,21(11):1409-1419.
[15]Schwaiblmair M,Faul C,von Scheidt W,et al.Ventilatory efficiency testing as prognostic value in patients with pulmonary hypertension[J].BMC Pulm Med,2012,7(6):12-23.
[16]Xi Q,Zhao Z,Liu Z,et al.The lowest VE/VCO(2)ratio best identifies chronic thromboembolic pulmonary hypertension[J].Thromb Res,2014,134(6):1208-1213.
[17]Ramos RP,Arakaki JS,Barbosa P,et al.Heart rate recovery in pulmonary arterial hypertension:relationship with exercise capacity and prognosis[J].Am Heart J,2012,163(4):580-588.
[18]Minai OA,Gudavalli R,Mummadi S,et al.Heart rate recovery predicts clinical worsening in patients with pulmonary arterial hypertension[J].Am J Respir Crit Care Med,2012,185(4):400-408.
[19]Baba R,Nagashima M,Goto M,et al.Oxygen uptake efficiency slope:a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise[J].J Am Coll Cardiol,1996,28(6):1567-1572.
[20]Akkerman M,van Brussel M,Hulzebos E,et al.The oxygen uptake efficiency slope:what do we know?[J].J Cardiopulm Rehabil Prev,2010,30(6):357-373.
[21]Tan XY,Yang W,Guo J,et al.Usefulness of decrease in oxygen uptake efficiency to identify gas exchange abnormality in patients with idiopathic pulmonary arterial hypertension[J].PLo S One,2014,9(6):e98889.
[22]Ramos RP,Ota-Arakaki JS,Alencar MC,et al.Exercise oxygen uptake efficiency slope independently predicts poor outcome in pulmonary arterial hypertension[J].Eur Respir J,2014,43(5):1510-1512.
[23]Tang Y,Luo Q,Liu Z,et al.Oxygen uptake efficiency slope predicts poor outcome in patients with idiopathic pulmonary arterial hypertension[J].J Am Heart Assoc,2017,6(7):e005037.
[2]Pinkstaff SO,Burger CD,Daugherty J,et al.Cardiopulmonary exercise testing in patients with pulmonary hypertension:clinical recommendations based on a review of the evidence[J].Expert Rev Respir Med,2016,10(3):279-295.
[3]Guazzi M,Adams V,Conraads V,et al.EACPR/AHA Joint Scientific Statement.Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations[J].Eur Heart J,2012,33(23):2917-2927.
[4]Guazzi M,Arena R,Halle M,et al.2016 Focused Update:Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations[J].Circulation,2016,133(24):e694-e711.
[5]文富强,袁玉茹,梁斌苗,等.心肺运动试验的原理及其解读——病理生理及临床应用[M].北京:科学出版社,2008:197-198.
[6]Mancini DM,Eisen H,Kussmaul W,et al.Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure[J].Circulation,1991,83(3):778-786.
[7]Sun XG,Hansen JE,Oudiz RJ,et al.Exercise pathophysiology in patients with primary pulmonary hypertension[J].Circulation,2001,104(4):429-435.
[8]Liu WH,Luo Q,Liu ZH,et al.Differences in exercise capacity in patients with chronic left heart failure and chronic right heart failure[J].Heart Lung Circ,2014,23(11):1036-1040.
[9]Liu WH,Luo Q,Liu ZH,et al.Differences in pulmonary function and exercise capacity in patients with idiopathic dilated cardiomyopathy and idiopathic pulmonary arterial hypertension[J].Heart Lung,2014,43(4):317-321.
[10]Wensel R,Opitz CF,Anker SD,et al.Assessment of survival in patients with primary pulmonary hypertension:importance of cardiopulmonary exercise testing[J].Circulation,2002,106(3):319-324.
[11]Wensel R,Francis DP,Meyer FJ,et al.Incremental prognostic value of cardiopulmonary exercise testing and resting haemodynamics in pulmonary arterial hypertension[J].Int J Cardiol,2013,167(4):1193-1198.
[12]Gitt AK,Wasserman K,Kilkowski C,et al.Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death[J].Circulation,2002,106(24):3079-3084.
[13]Deboeck G,Scoditti C,Huez S,et al.Exercise testing to predict outcome in idiopathic versus associated pulmonary arterial hypertension[J].Eur Respir J,2012,40(6):1410-1419.
[14]Ferreira EV,Ota-Arakaki JS,Ramos RP,et al.Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension[J].Eur J Prev Cardiol,2014,21(11):1409-1419.
[15]Schwaiblmair M,Faul C,von Scheidt W,et al.Ventilatory efficiency testing as prognostic value in patients with pulmonary hypertension[J].BMC Pulm Med,2012,7(6):12-23.
[16]Xi Q,Zhao Z,Liu Z,et al.The lowest VE/VCO(2)ratio best identifies chronic thromboembolic pulmonary hypertension[J].Thromb Res,2014,134(6):1208-1213.
[17]Ramos RP,Arakaki JS,Barbosa P,et al.Heart rate recovery in pulmonary arterial hypertension:relationship with exercise capacity and prognosis[J].Am Heart J,2012,163(4):580-588.
[18]Minai OA,Gudavalli R,Mummadi S,et al.Heart rate recovery predicts clinical worsening in patients with pulmonary arterial hypertension[J].Am J Respir Crit Care Med,2012,185(4):400-408.
[19]Baba R,Nagashima M,Goto M,et al.Oxygen uptake efficiency slope:a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise[J].J Am Coll Cardiol,1996,28(6):1567-1572.
[20]Akkerman M,van Brussel M,Hulzebos E,et al.The oxygen uptake efficiency slope:what do we know?[J].J Cardiopulm Rehabil Prev,2010,30(6):357-373.
[21]Tan XY,Yang W,Guo J,et al.Usefulness of decrease in oxygen uptake efficiency to identify gas exchange abnormality in patients with idiopathic pulmonary arterial hypertension[J].PLo S One,2014,9(6):e98889.
[22]Ramos RP,Ota-Arakaki JS,Alencar MC,et al.Exercise oxygen uptake efficiency slope independently predicts poor outcome in pulmonary arterial hypertension[J].Eur Respir J,2014,43(5):1510-1512.
[23]Tang Y,Luo Q,Liu Z,et al.Oxygen uptake efficiency slope predicts poor outcome in patients with idiopathic pulmonary arterial hypertension[J].J Am Heart Assoc,2017,6(7):e005037.