Russian Heart Failure Journal 2008year Muscle status and exercise tolerance in patients with different degrees of chronic pulmonary hypertension


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2008/

Muscle status and exercise tolerance in patients with different degrees of chronic pulmonary hypertension

Sumin A.N., Arkhipov O.G., Snitskaya N.A.

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Urgency. Exercise tolerance (ET) not only defines the quality of life but also serves as a criterion for treatment efficacy in patients with pulmonary hypertension (PH). In these patients, exercise tolerance may depend on impaired ventilation-perfusion ratio because of PH; tissue hypoperfusion due to development of HF; and condition of skeletal muscles. A relative contribution of these changes to physical working ability of these patients remains unclear. Aim. To study muscle status in patients with PH of different degrees and to identify factors which influence ET in these patients. Materials and methods. Study enrolled 96 patients (91 men and 5 women) aged 59 ± 0.8 years, with pathology of the respiratory system complicated by chronic PH. Patients were randomized to four groups by their mean pulmonary artery pressure (MPAP): PH1 (MPAP, 20–30 mm Hg, n=50), PH2 (MPAP, 30–40 mm Hg, n=18), PH3 (MPAP >40 mm Hg, n=10), and control group (MPAP <20 mm Hg, n=18). In addition to clinical evaluation, patients underwent echoCG, bicycle ergometry (BEM), 6-min walking test (WT-6), spirometry, statico-dynamic and static tests. Results. With increasing PH severity in patients with lung pathology, dimensions of right heart chambers and thickness of the right ventricular myocardium increased whereas right ventricular EF reduced. Patients with pronounced PH showed a statistically non-significant trend to reduced ET. Muscle status did not considerably change with higher degrees of PH. Correlation analysis showed that physical working ability of patients with PH depended on the condition of skeletal muscles and severity of ventilation disorders rather than on parameters of intracardiac hemodynamics and MPAP. Multiple regression analysis showed that muscular force of upper and lower extremities and spirometric parameters were independently and significantly associated with ET during BEM.
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