Volume 9: Issue 2

Gerilynn L. Connors, RRT, BS, FAACVPRClinical Manager, Pulmonary RehabilitationInova Fairfax HospitalFalls Church, VA

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Pulmonary rehabilitation (PR) should be considered an adjunct therapy for the pulmonary hypertension (PH) patient. The definition of PR published by the American Thoracic Society (ATS)/European Respiratory Society (ERS) in 2006 states: “Pulmonary rehabilitation is evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory disease who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, pulmonary

Summaries and commentaries from the section editors and invited reviewers present a clinical context for practitioners' application of the latest published research relevant to care of patients with pulmonary hypertension. In this issue, Nick Kim, MD, provides reviews.

Pulmonary hypertension (PH) is often diagnosed late in its course when it purports a particularly poor prognosis. Exercise effectively unmasks early forms of several cardiopulmonary diseases but the role of performing pulmonary arterial pressure measurements during exercise in the evaluation of PH remains unclear. Whether pulmonary arterial pressure-flow relationships during exercise may provide a window into earlier diagnosis of functionally significant pulmonary arterial hypertension and left ventricular dysfunction or add incrementally to our armamentarium of diagnostic tests and prognostic indicators in PH is the topic of active ongoing investigation. Evidence is emerging that abnormal pulmonary arterial pressure response patterns to exercise, when properly indexed to increased blood flow, may help to identify early forms of heart failure and pulmonary arterial hypertension. This article will discuss approaches to performing hemodynamic measurements during exercise as well as the potential clinical utility of identifying normal and abnormal pulmonary vascular response patterns to exercise.

Diagnosis of unexplained exertional dyspnea or fatigue is a significant challenge. When routine cardiac and pulmonary evaluations are unrevealing, cardiopulmonary exercise testing (CPET) with invasive hemodynamic monitoring may reveal the abnormal physiology causing these symptoms. In this review, the authors describe the protocol for invasive CPET at Massachusetts General Hospital, and present cases of exercise-induced pulmonary arterial hypertension and exercise-induced heart failure with preserved ejection fraction, as well as a new entity, preload failure, to demonstrate the utility of invasive CPET in the evaluation of unexplained exertional dyspnea. Indeed, exercise-induced pulmonary hypertension may represent early disease where prompt therapeutic intervention may improve outcome. When compared to noninvasive CPET or exercise stress echocardiography, invasive CPET has significant advantages in identifying the etiology of elevated pulmonary pressures and determining the influence of central hemodynamics on exercise capacity. For this reason, we expect that invasive CPET will assume a more prominent role in the evaluation and management of pulmonary hypertension.

Exercising Our Resources About PH

Pulmonary Rehabilitation's Role in Pulmonary Hypertension

Reviews of the Latest Published Research

Pulmonary Vascular Response Patterns to Exercise: Is There a Role for Pulmonary Arterial Pressure Assessment During Exercise in the Post-Dana Point Era?

Cardiopulmonary Exercise Testing in the Evaluation of Unexplained Dyspnea

What Can be Learned in 6 Minutes? 6-Minute Walk Test Primer and Role in Pulmonary Arterial Hypertension

Exercise Training and Pulmonary Rehabilitation in the Pulmonary Hypertension Patient

Simvastatin as a Treatment for PAH

What is the Impact of Obesity in PH?

Conference Abstracts

Guest Editor’s Memo

A Roundtable Discussion Addressing Patient-Centered Care and Quality of Life in Patients With Pulmonary Arterial Hypertension

Editor’s Memo

Pulmonary Hypertension Associated With Parenchymal Lung Disease