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DOI: 10.1055/s-0035-1544809
Improvement of dead space ventilation, gas exchange, functional capacity and quality of life following pulmonary endarterectomy
Background: Cardiopulmonary exercise test has been shown to be helpful for detection of subjects with chronic thromboembolic pulmonary hypertension, even in patients with normal echocardiography. The prognostic value of oxygen uptake and systolic blood pressure under exercise conditions has been reported.
It remains unclear when functional capacity, dead space ventilation and gas exchange improve following pulmonary endarterectomy.
Methods: We studied cardiopulmonary exercise test, six minute walking test and quality of life in 15 patients undergoing pulmonary endartrectomy.
Results: Anthropometric and haemodynamic baseline characteristics were as follows: age 59.2 ± 12.5, mPAP 35 ± 15 mm Hg, PAWP 9 ± 3 mmHg, CO 5.0 ± 1.3 l/min, CI 2.9 ± 0.8 l/min/m2, RAP 7.7 ± 5.5 mm Hg.
After 3 months VDe/VT was reduced from 20.2 ± 9.4 to 15.2 ± 5.7 (p = 0.03) and P(A-a)O2 decreased from 46.7 ± 23 mm Hg to 36.1 ± 21.3 mm Hg (p = 0.01) after 3 months and to 28.4 ± 12.3 mm Hg (p = 0.02) after 12 months following PEA.
We noticed a significant increase of six minute walking distance + 26 m ± 3 m (p = 0.03) and a decrease of VE/VCO2-Slope from 41.6 ± 36.4 between 3 and 12 months after PEA (p = 0.04). Quality of life measured by EQ5D improved from 46 to 70% after 12 months following PEA (p = 0.003).
Conclusion: Whereas dead space ventilation and gas exchange improve early after PEA, improvement of six-minute walking distance and normalization of hyperventilation are shown to need more time for improvement.