Clinical Investigation| Volume 20, ISSUE 7, P485-491, July 2014

Hemodynamic Ranges During Daily Activities and Exercise Testing in Patients With Pulmonary Arterial Hypertension



      In patients with pulmonary arterial hypertension (PAH) the relationship between hemodynamic impairment experienced during daily activity and that during exercise testing is not known.

      Methods and Results

      Ten PAH patients received an implantable hemodynamic monitor that continuously recorded and stored right ventricular systolic (RVSP) and mean pulmonary arterial (MPAP) pressures. Before starting a new PAH treatment (baseline) and after 12 weeks on treatment, a 6-minute walk test (6MWT) and a maximal walk test (MAXWT) were performed. Exercise pressure range was measured as the difference between rest before exercise and maximal pressure during 6MWT or MAXWT. Ambulatory range (AMB) was measured as the difference between the lowest (4th percentile) and highest (96th percentile) values recorded over 24 hours. One week of AMBs were averaged for each patient before each exercise test. Mean age was 54 ±18 years, 9 were female, and all were in World Health Organization functional class III. At baseline, RVSP and MPAP increased, respectively, 136 ± 49% and 164 ± 49% during AMB, 63 ± 26% and 79 ± 30% during MAXWT, and 59 ± 32% and 69 ± 33% during 6MWT. There was no difference in pressure change at 12 weeks.


      Changes in RV and PA pressures during exercise tests were relatively small compared with the range seen during ambulatory conditions.

      Key Words

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        • McGoon M.
        • Gutterman D.
        • Steen V.
        • Barst R.
        • McCrory D.C.
        • Fortin T.A.
        • Loyd J.E.
        • American College of Chest Physicians
        Screening, early detection, and diagnosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines.
        Chest. 2004; 126: 14S-34S
        • d'Alonzo G.E.
        • Gianotti L.A.
        • Pohil R.L.
        • Reagle R.R.
        • DuRee S.L.
        • Fuentes F.
        • Dantzker D.R.
        Comparison of progressive exercise performance of normal subjects and patients with primary pulmonary hypertension.
        Chest. 1987; 92: 57-62
        • McLaughlin V.V.
        • McGoon M.D.
        Pulmonary arterial hypertension.
        Circulation. 2006; 114: 1417-1431
        • Galie N.
        • Manes A.
        • Branzi A.
        Evaluation of pulmonary arterial hypertension.
        Curr Opin Cardiol. 2004; 19: 575-581
        • Miyamoto S.
        • Nagaya N.
        • Satoh T.
        • Kyotani S.
        • Sakamaki F.
        • Fujita M.
        • et al.
        Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing.
        Am J Respir Crit Care Med. 2000; 161: 487-492
        • Deboeck G.
        • Niset G.
        • Vachiery J.L.
        • Moraine J.J.
        • Naeije R.
        Physiological response to the six-minute walk test in pulmonary arterial hypertension.
        Eur Respir J. 2005; 26: 667-672
        • Riley M.S.
        • Porszasz J.
        • Engelen M.P.
        • Shapiro S.M.
        • Brundage B.H.
        • Wasserman K.
        Responses to constant work rate bicycle ergometry exercise in primary pulmonary hypertension: the effect of inhaled nitric oxide.
        J Am Coll Cardiol. 2000; 36: 547-556
        • Frost A.E.
        • Langleben D.
        • Oudiz R.
        • Hill N.
        • Horn E.
        • McLaughlin V.
        • et al.
        The 6-min walk test (6MW) as an efficacy endpoint in pulmonary arterial hypertension clinical trials: demonstration of a ceiling effect.
        Vascul Pharmacol. 2005; 43: 36-39
        • Bennett T.
        • Kjellstrom B.
        • Taepke R.
        • Ryden L.
        Development of implantable devices for continuous ambulatory monitoring of central hemodynamic values in heart failure patients.
        Pacing Clin Electrophysiol. 2005; 28: 573-584
        • Magalski A.
        • Adamson P.
        • Gadler F.
        • Boehm M.
        • Steinhaus D.
        • Reynolds D.
        • et al.
        Continuous ambulatory right heart pressure measurements with an implantable hemodynamic monitor: a multicenter, 12-month follow-up study of patients with chronic heart failure.
        J Card Fail. 2002; 8: 63-70
        • Fruhwald F.M.
        • Kjellstrom B.
        • Perthold W.
        • Watzinger N.
        • Maier R.
        • Grandjean P.A.
        • Klein W.
        Continuous hemodynamic monitoring in pulmonary hypertensive patients treated with inhaled iloprost.
        Chest. 2003; 124: 351-359
        • Frantz R.P.
        • Benza R.L.
        • Kjellström B.
        • Bourge R.C.
        • Barst R.J.
        • Bennett T.D.
        • McGoon M.D.
        Continuous hemodynamic monitoring in patients with pulmonary arterial hypertension.
        J Heart Lung Transpl. 2008; 27: 780-788
        • Reynolds D.W.
        • Bartelt N.
        • Taepke R.
        • Bennett T.D.
        Measurement of pulmonary artery diastolic pressure from the right ventricle.
        J Am Coll Cardiol. 1995; 25: 1176-1182
        • Ohlsson A.
        • Bennett T.
        • Nordlander R.
        • Rydén J.
        • Aström H.
        • Rydén L.
        Monitoring of pulmonary arterial diastolic pressure through a right ventricular pressure transducer.
        J Card Fail. 1995; 1: 161-168
        • Kjellstrom B.
        • Igel D.
        • Abraham J.
        • Bennett T.
        • Bourge R.
        Trans-telephonic monitoring of continuous haemodynamic measurements in heart failure patients.
        J Telemed Telecare. 2005; 11: 240-244
        • Mathai S.C.
        • Puhan M.A.
        • Lam D.
        • Wise R.A.
        The minimal important difference in the six minute walk test for patients with pulmonary arterial hypertension.
        Am J Respir Crit Care Med. 2012; 186: 428-433
        • Gan C.T.
        • Lankhaar J.W.
        • Westerhof N.
        • Marcus J.T.
        • Becker A.
        • Twisk J.W.
        • et al.
        Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension.
        Chest. 2007; 132: 1906-1912
        • van de Veerdonk M.C.
        • Kind T.
        • Marcus J.T.
        • Mauritz G.J.
        • Heymans M.W.
        • Bogaard H.
        • et al.
        Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy.
        J Am Coll Cardiol. 2011; 58: 2511-2519
        • Wonisch M.
        • Fruhwald F.
        • Maier R.
        • Watzinger N.
        • Hödl R.
        • Kraxner W.
        • et al.
        Continuous hemodynamic monitoring during incremental exercise in patients with pulmonary hypertension treated with inhalative prostanoids.
        Int J Cardiol. 2005; 101: 415-420
        • Tiede H.
        • Sommer N.
        • Milger K.
        • Voswinckel R.
        • Bandorski D.
        • Schermuly R.T.
        • et al.
        Short-term improvement in pulmonary hemodynamics is strongly predictive of long-term survival in patients with pulmonary arterial hypertension.
        Pulm Circ. 2013; 3: 523-532
        • Benza R.L.
        • Miller D.P.
        • Barst R.J.
        • Badesch D.B.
        • Frost A.E.
        • McGoon M.D.
        An evaluation of long-term survival from time of diagnosis in pulmonary arterial hypertension from the REVEAL registry.
        Chest. 2012; 142: 448-456
        • Karamanoglu M.
        • Bennett T.
        • Stahlberg M.
        • Splett V.
        • Kjellstrom B.
        • Linde C.
        • Braunschweig F.
        Estimation of cardiac output in patients with congestive heart failure by analysis of right ventricular pressure waveforms.
        Biomed Eng Online. 2011; 10: 36