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

To access this material please log in or register

Register Authorize

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

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



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.
    1.    Taichman DB, Shin J, Hud L et al. Health-related quality of life in patients with pulmonary arterial hypertension. Respir Res. 2005 Aug 10;6:92.
    2.    Naeije R. Pulmonary Hypertension and Right Heart Failure in Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc. 2005;2 (1):20–22.
    3.    Cenedese E, Speich R, Dorschner L et al. Measurement of quality of life in pulmonary hypertension and its significance. Eur Respir J. 2006;28 (4):808–815.
    4.    Chua R, Keogh A. M, Byth K, O’Loughlin A. Comparison and validation of three measures of quality of life in patients with pulmonary hypertension. Intern Med J. 2006;36 (11):705–710.
    5.    Morelli S, Ferrante L, Sgreccia A et al. Pulmonary hypertension is associated with impaired exercise performance in patients with systemic sclerosis. Scand J Rheumatol. 2000;29 (4):236–242.
    6.    Hasuda T, Okano Y, Yoshioka T et al. Pulmonary pressure-flow relation as a determinant factor of exercise capacity and symptoms in patients with regurgitant valvular heart disease. Int J Cardiol. 2005;99 (3):403–407.
    7.    Ewert R, Opitz CF, Wensel R et al. Assessment of Cardiopulmonary Function at Rest and during Exercise in Patients with Pulmonary Hypertension. Herz. 2005;30 (4):318–325.
    8.    Chenivesse C, Rachenne V, Fournier C et al. Cardiopulmonary exercise testing in exercise-induced pulmonary hypertension. Rev Mal Respir. 2006;23 (2 Pt 1):141–148.
    9.    Rubin LJ. Primary pulmonary hypertension. N Engl J Med. 1997;336 (2):111–117.
    10.    Leuchte HH, Neurohr C, Baumgartner R et al. Brain natriuretic peptide and exercise capacity in lung fibrosis and pulmonary hypertension. Am J Respir Crit Care Med. 2004;170 (4):360–365.
    11.    Zafrir N, Zingerman B, Solodky A et al. Use of noninvasive tools in primary pulmonary hypertension to assess the correlation of right ventricular function with functional capacity and to predict outcome. Int J Cardiovasc Imaging. 2007;23 (2):209–215.
    12.    Hoeper MM, Oudiz RJ, Peacock A et al. End points and clinical trial designs in pulmonary arterial hypertension: clinical and regulatory perspectives. J Am Coll Cardiol. 2004;43 (12 Suppl S):48S-55S.
    13.    Newman JH, Robbins IM. Exercise training in pulmonary hypertension: implications for the evaluation of drug trials. Circulation. 2006;114 (14):1448–1449.
    14.    Задионченко В. С, Погонченкова И. В, Гринёва З. О. и др. Хроническое лёгочное сердце. Росс. кардиол. журнал. 2003;4:6–11.
    15.    Sun XG, Hansen JE, Oudiz RJ, Wasserman K. Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation. 2001;104 (4):429–435
    16.    Meyer FJ, Lossnitzer D, Kristen AV et al. Respiratory muscle dysfunction in idiopathic pulmonary arterial hypertension. Eur Respir J. 2005;25 (1):125–130.
    17.    Bauer R, Dehnert C, Schoene P et al. Skeletal muscle dysfunction in patients with idiopathic pulmonary arterial hypertension. Respir Med. 2007;101 (11):2366–2369.
    18.    Mereles D, Ehlken N, Kreuscher S et al. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation. 2006;114 (14):1482–1489.
    19.    Rubin LJ, Galie N. Pulmonary arterial hypertension: a look to the future. J Am Coll Cardiol. 2004;43 (12 Suppl S):89S-90S.
    20.    Franz IW, Van Der Meyden J, Schaupp S, Tönnesmann U. The effect of amlodipine on exercise-induced pulmonary hypertension and right heart function in patients with chronic obstructive pulmonary disease. Z Kardiol. 2002;91 (10):833–839.
    21.    Cotrim C, Simões O, Loureiro MJ et al. Stress echocardiography in the evaluation of exercise physiology in patients with severe arterial pulmonary hypertension. New methodology. Rev Port Cardiol. 2005;24 (12):1451–1460.
    22.    Alkotob ML, Soltani P, Sheatt MA et al. Reduced exercise capacity and stress-induced pulmonary hypertension in patients with scleroderma. Chest. 2006;130 (1):176–181.
    23.    Provencher S, Chemla D, Hervé P et al. Heart rate responses during the 6‑minute walk test in pulmonary arterial hypertension. Eur Respir J. 2006;27 (1):114–120.
    24.    Miyamoto S, Nagaya N, Satoh T 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 (2 Pt 1):487–492.
    25.    Yasunobu Y, Oudiz RJ, Sun XG et al. End-tidal PCO2 abnormality and exercise limitation in patients with primary pulmonary hypertension. Chest. 2005;127 (5):1637–1646.
    26.    Larsen AI, Lindal S, Aukrust P et al. Effect of exercise training on skeletal muscle fibre characteristics in men with chronic heart failure. Correlation between skeletal muscle alterations, cytokines and exercise capacity. Int J Cardiol. 2002;83 (1):25–32.
    27.    Dobsak P, Novakova M, Siegelova J et al. Low-frequency electrical stimulation increases muscle strength and improves blood supply in patients with chronic heart failure. Circ J. 2006;70 (1):75–82.
    28.    Gielen S, Adams V, Mobius-Winkler S et al. Anti-inflammatory effects of exercise training in the skeletal muscle of patients with chronic heart failur. J Am Coll Cardiol. 2003;42 (5):861–868.
    29.    Petersen AM, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol. 2005;98 (4):1154–1162.
    30.    Granton JT, Naughton MT, Benard DC et al. CPAP improves inspiratory muscle strength in patients with heart failure and central sleep apnea. Am J Respir Crit Care Med. 1996;153 (1):277–282.
    31.    Mancini DM, Henson D, La MJ et al. Benefit of selective respiratory muscle training on exercise capacity in patients with chronic congestive heart failure. Circulation. 1995;91 (2):320–329.
    32.    Piepoli M, Ponikowski PP, Clark AL et al. A neural link to explain the «muscle hypothesis» of exercise intolerance in chronic heart failure. Am Heart J. 1999;137 (6):1050–1056.
    33.    Нulsmann M, Quittan M, Berger R et al. Muscle strength as a predictor of long-term survival in severe congestive heart failure. Eur J Heart Fail. 2004;6 (1):101–107.
    34.    Сумин А. Н., Кобякова О. В., Галимзянов Д. М. Прогностическое значение показателей диастолической функции левого желудочка и мышечного статуса у пожилых пациентов, перенесших инфаркт миокарда. Кардиология. 2007;47 (6):45–50.
    35.    Uchi M, Saji T, Harada T. Feasibility of cardiopulmonary rehabilitation in patients with idiopathic pulmonary arterial hypertension treated with intravenous prostacyclin infusion therapy. J Cardiol. 2005;46 (5):183–193.

To access this material please log in or register

Register Authorize
Ru En