Effect of Supervised Training Therapy on Pulmonary Arterial Compliance and Stroke Volume in Severe Pulmonary Arterial Hypertension and Inoperable or Persistent Chronic Thromboembolic Pulmonary Hypertension

Respiration. 2021;100(5):369-378. doi: 10.1159/000512316. Epub 2021 Mar 25.

Abstract

Background: Pulmonary arterial compliance (PAC) is a prognostic parameter in pulmonary arterial hypertension (PAH) reflecting the elasticity of the pulmonary vessels.

Objectives: The objective of this post hoc analysis of a prospective randomized controlled trial (RCT) was to assess the effect of exercise training on PAC and stroke volume (SV) in patients with PAH and persistent/inoperable chronic thromboembolic pulmonary hypertension (CTEPH).

Method: From the previous RCT, 43 out of 87 patients with severe PAH (n = 29) and CTEPH (n = 14) had complete haemodynamic examinations at baseline and after 15 weeks by right heart catheterization and were analysed (53% female, 79% World Health Organization functional class III/IV, 58% combination therapy, 42% on supplemental oxygen therapy, training group n = 24, and control group n = 19). Medication remained unchanged for all patients.

Results: Low-dose exercise training at 4-7 days/week significantly improved PAC (training group 0.33 ± 0.65 mL/mm Hg vs. control group -0.06 ± 1.10 mL/mm Hg; mean difference 0.39 mL/mm Hg, 95% confidence interval [CI] 0.15-0.94 mL/mm Hg; p = 0.004) and SV (training group 9.9 ± 13.4 mL/min vs. control group -4.2 ± 11.0 mL/min; mean difference 14.2 mL, 95% CI 6.5-21.8 mL; p < 0.001) in the training versus control group. Furthermore, exercise training significantly improved cardiac output and pulmonary vascular resistance at rest, peak oxygen consumption, and oxygen pulse.

Conclusions: Our findings suggest that supervised exercise training may improve right ventricular function and PAC at the same time. Further prospective studies are needed to evaluate these findings.

Keywords: Pulmonary arterial compliance; Pulmonary arterial hypertension; Pulmonary hypertension; Right heart catheter; Stroke volume; Training.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Biomarkers / metabolism
  • Exercise Therapy / methods*
  • Female
  • Hemodynamics
  • Humans
  • Hypertension, Pulmonary / physiopathology
  • Hypertension, Pulmonary / rehabilitation*
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / metabolism
  • Oxygen Consumption / physiology
  • Peptide Fragments / metabolism
  • Prospective Studies
  • Pulmonary Wedge Pressure
  • Stroke Volume*
  • Thromboembolism / physiopathology
  • Thromboembolism / rehabilitation*
  • Vascular Resistance / physiology*
  • Ventricular Dysfunction, Right / physiopathology
  • Ventricular Dysfunction, Right / rehabilitation*

Substances

  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain