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Exercise in Pulmonary Vascular Diseases

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Exercise and Sports Pulmonology

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Abstract

Pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension are the most common diseases of pulmonary vasculature. The physiological derangements of pulmonary hypertension result in characteristic abnormalities observed during dynamic exercise and often lead to dyspnoea and exercise intolerance. Impaired cardiac function results in reduced aerobic capacity, low anaerobic threshold and reduced value of the relationship between oxygen uptake and work rate (ΔV′O2/ΔWR). Both high physiologic dead space and chemosensitivity contribute to elevated ratio of minute ventilation to CO2 output (V′E/V′CO2) during exercise testing. Consequently, resting hypocapnia with low end-tidal PCO2 throughout exercise is typically observed and is related to the severity of disease. Exertional hypoxaemia is also a variable but frequent finding during exercise, which can be related to ventilation-perfusion heterogeneity, low mixed venous O2 content from impaired cardiac output and right-to-left shunting through a patent foramen ovale. Even in the absence of significant resting airflow obstruction, dynamic hyperinflation can occur in pulmonary vascular diseases, which contributes to exertional dyspnoea and exercise intolerance. Peripheral muscle dysfunction is another common component of exercise pathophysiology in these conditions.

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References

  1. Galiè N, Humbert M, Vachiery J-L, et al. ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J. 2015;46:903–75.

    PubMed  Google Scholar 

  2. Guignabert C, Dorfmüller P. Pathology and pathobiology of pulmonary hypertension. Semin Respir Crit Care Med. 2017;38:571–84.

    PubMed  Google Scholar 

  3. Gall H, Hoeper MM, Richter MJ, Cacheris W, Hinzmann B, Mayer E. An epidemiological analysis of the burden of chronic thromboembolic pulmonary hypertension in the USA, Europe and Japan. Eur Respir Rev. 2017;26:160121.

    PubMed  Google Scholar 

  4. Simonneau G, Torbicki A, Dorfmüller P, Kim N. The pathophysiology of chronic thromboembolic pulmonary hypertension. Eur Respir Rev. 2017;26:160112.

    PubMed  Google Scholar 

  5. Motoji Y, Forton K, Pezzuto B, Faoro V, Naeije R. Resistive or dynamic exercise stress testing of the pulmonary circulation and the right heart. Eur Respir J. 2017;50:1700151.

    PubMed  Google Scholar 

  6. Weatherald J, Farina S, Bruno N, Laveneziana P. Cardiopulmonary exercise testing in pulmonary hypertension. Ann Am Thorac Soc. 2017;14:S84–92.

    PubMed  Google Scholar 

  7. Kovacs G, Olschewski A, Berghold A, Olschewski H. Pulmonary vascular resistances during exercise in normal subjects: a systematic review. Eur Respir J. 2012;39:319–28.

    CAS  PubMed  Google Scholar 

  8. Lau EMT, Chemla D, Godinas L, et al. Loss of vascular Distensibility during exercise is an early hemodynamic marker of pulmonary vascular disease. Chest. 2016;149:353–61.

    PubMed  Google Scholar 

  9. Lau EMT, Godinas L, Sitbon O, et al. Resting pulmonary artery pressure of 21-24 mmHg predicts abnormal exercise haemodynamics. Eur Respir J. 2016;47:1436–44.

    CAS  PubMed  Google Scholar 

  10. Kovacs G, Avian A, Wutte N, et al. Changes in pulmonary exercise haemodynamics in scleroderma: a 4-year prospective study. Eur Respir J. 2017;50:1601708.

    PubMed  Google Scholar 

  11. Janicki JS, Weber KT, Likoff MJ, Fishman AP. The pressure-flow response of the pulmonary circulation in patients with heart failure and pulmonary vascular disease. Circulation. 1985;72:1270–8.

    CAS  PubMed  Google Scholar 

  12. Belenkie I, Dani R, Smith ER, Tyberg JV. Ventricular interaction during experimental acute pulmonary embolism. Circulation. 1988;78:761–8.

    CAS  PubMed  Google Scholar 

  13. Belenkie I, Dani R, Smith ER, Tyberg JV. Effects of volume loading during experimental acute pulmonary embolism. Circulation. 1989;80:178–88.

    CAS  PubMed  Google Scholar 

  14. Nootens M, Wolfkiel CJ, Chomka EV, Rich S. Understanding right and left ventricular systolic function and interactions at rest and with exercise in primary pulmonary hypertension. Am J Cardiol. 1995;75:374–7.

    CAS  PubMed  Google Scholar 

  15. Holverda S, Gan CT-J, Marcus JT, Postmus PE, Boonstra A, Vonk-Noordegraaf A. Impaired stroke volume response to exercise in pulmonary arterial hypertension. J Am Coll Cardiol. 2006;47:1732–3.

    PubMed  Google Scholar 

  16. Naeije R, Badagliacca R. The overloaded right heart and ventricular interdependence. Cardiovasc Res. 2017;113:1474–85.

    CAS  PubMed  Google Scholar 

  17. Chemla D, Castelain V, Hoette S, et al. Strong linear relationship between heart rate and mean pulmonary artery pressure in exercising patients with severe precapillary pulmonary hypertension. Am J Physiol Heart Circ Physiol. 2013;305:H769–77.

    CAS  PubMed  Google Scholar 

  18. Groepenhoff H, Westerhof N, Jacobs W, Boonstra A, Postmus PE, Vonk-Noordegraaf A. Exercise stroke volume and heart rate response differ in right and left heart failure. Eur J Heart Fail. 2010;12:716–20.

    PubMed  Google Scholar 

  19. Blumberg FC, Arzt M, Lange T, Schroll S, Pfeifer M, Wensel R. Impact of right ventricular reserve on exercise capacity and survival in patients with pulmonary hypertension. Eur J Heart Fail. 2013;15:771–5.

    PubMed  Google Scholar 

  20. van Kan C, van der Plas MN, Reesink HJ, et al. Hemodynamic and ventilatory responses during exercise in chronic thromboembolic disease. J Thorac Cardiovasc Surg. 2016;152:763–71.

    PubMed  Google Scholar 

  21. Sun XG, Hansen JE, Oudiz RJ, Wasserman K. Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation. 2001;104:429–35.

    CAS  PubMed  Google Scholar 

  22. Riley MS, Pórszász J, Engelen MP, Brundage BH, Wasserman K. Gas exchange responses to continuous incremental cycle ergometry exercise in primary pulmonary hypertension in humans. Eur J Appl Physiol. 2000;83:63–70.

    CAS  PubMed  Google Scholar 

  23. Deboeck G, Niset G, Lamotte M, Vachiéry JL, Naeije R. Exercise testing in pulmonary arterial hypertension and in chronic heart failure. Eur Respir J. 2004;23:747–51.

    CAS  PubMed  Google Scholar 

  24. Potus F, Malenfant S, Graydon C, et al. Impaired angiogenesis and peripheral muscle microcirculation loss contribute to exercise intolerance in pulmonary arterial hypertension. Am J Respir Crit Care Med. 2014;190:318–28.

    CAS  PubMed  Google Scholar 

  25. Mainguy V, Maltais F, Saey D, et al. Peripheral muscle dysfunction in idiopathic pulmonary arterial hypertension. Thorax. 2010;65:113–7.

    PubMed  Google Scholar 

  26. Wensel R, Opitz CF, Anker SD, et al. Assessment of survival in patients with primary pulmonary hypertension: importance of cardiopulmonary exercise testing. Circulation. 2002;106:319–24.

    PubMed  Google Scholar 

  27. Imai K, Sato H, Hori M, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol. 1994;24:1529–35.

    CAS  PubMed  Google Scholar 

  28. Ramos RP, Arakaki JSO, Barbosa P, et al. Heart rate recovery in pulmonary arterial hypertension: relationship with exercise capacity and prognosis. Am Heart J. 2012;163:580–8.

    PubMed  Google Scholar 

  29. Riley MS, Pórszász J, Engelen MP, Shapiro SM, Brundage BH, 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;36:547–56.

    CAS  PubMed  Google Scholar 

  30. Theodore J, Robin ED, Morris AJ, et al. Augmented ventilatory response to exercise in pulmonary hypertension. Chest. 1986;89:39–44.

    CAS  PubMed  Google Scholar 

  31. D’Alonzo GE, Gianotti LA, Pohil RL, et al. Comparison of progressive exercise performance of normal subjects and patients with primary pulmonary hypertension. Chest. 1987;92:57–62.

    PubMed  Google Scholar 

  32. Sun X-G, Hansen JE, Oudiz RJ, Wasserman K. Pulmonary function in primary pulmonary hypertension. J Am Coll Cardiol. 2003;41:1028–35.

    PubMed  Google Scholar 

  33. Laveneziana P, Garcia G, Joureau B, et al. Dynamic respiratory mechanics and exertional dyspnoea in pulmonary arterial hypertension. Eur Respir J. 2013;41:578–87.

    CAS  PubMed  Google Scholar 

  34. Meyer FJ, Ewert R, Hoeper MM, et al. Peripheral airway obstruction in primary pulmonary hypertension. Thorax. 2002;57:473–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Richter MJ, Voswinckel R, Tiede H, et al. Dynamic hyperinflation during exercise in patients with precapillary pulmonary hypertension. Respir Med. 2012;106:308–13.

    PubMed  Google Scholar 

  36. de Man FS, van Hees HWH, Handoko ML, et al. Diaphragm muscle fiber weakness in pulmonary hypertension. Am J Respir Crit Care Med. 2011;183:1411–8.

    PubMed  Google Scholar 

  37. Manders E, Bonta PI, Kloek JJ, et al. Reduced force of diaphragm muscle fibers in patients with chronic thromboembolic pulmonary hypertension. Am J Physiol Lung Cell Mol Physiol. 2016;311:L20–8.

    PubMed  PubMed Central  Google Scholar 

  38. Meyer FJ, Lossnitzer D, Kristen AV, et al. Respiratory muscle dysfunction in idiopathic pulmonary arterial hypertension. Eur Respir J. 2005;25:125–30.

    CAS  PubMed  Google Scholar 

  39. Laveneziana P, Humbert M, Godinas L, et al. Inspiratory muscle function, dynamic hyperinflation and exertional dyspnoea in pulmonary arterial hypertension. Eur Respir J. 2015;45:1495–8.

    PubMed  Google Scholar 

  40. Sun X-G, Hansen JE, Garatachea N, Storer TW, Wasserman K. Ventilatory efficiency during exercise in healthy subjects. Am J Respir Crit Care Med. 2002;166:1443–8.

    PubMed  Google Scholar 

  41. Vicenzi M, Deboeck G, Faoro V, Loison J, Vachiery J-L, Naeije R. Exercise oscillatory ventilation in heart failure and in pulmonary arterial hypertension. Int J Cardiol. 2016;202:736–40.

    PubMed  Google Scholar 

  42. Reybrouck T, Mertens L, Schulze-Neick I, et al. Ventilatory inefficiency for carbon dioxide during exercise in patients with pulmonary hypertension. Clin Physiol. 1998;18:337–44.

    CAS  PubMed  Google Scholar 

  43. Liu W-H, Luo Q, Liu Z-H, et al. Pulmonary function differences in patients with chronic right heart failure secondary to pulmonary arterial hypertension and chronic left heart failure. Med Sci Monit. 2014;20:960–6.

    PubMed  PubMed Central  Google Scholar 

  44. McCabe C, Deboeck G, Harvey I, et al. Inefficient exercise gas exchange identifies pulmonary hypertension in chronic thromboembolic obstruction following pulmonary embolism. Thromb Res. 2013;132:659–65.

    CAS  PubMed  Google Scholar 

  45. Xi Q, Zhao Z, Liu Z, Ma X, Luo Q, Liu W. The lowest VE/VCO2 ratio best identifies chronic thromboembolic pulmonary hypertension. Thromb Res. 2014;134:1208–13.

    CAS  PubMed  Google Scholar 

  46. Zhai Z, Murphy K, Tighe H, et al. Differences in ventilatory inefficiency between pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Chest. 2011;140:1284–91.

    PubMed  Google Scholar 

  47. Godinas L, Sattler C, Lau EM, et al. Dead-space ventilation is linked to exercise capacity and survival in distal chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant. 2017;36:1234–42.

    PubMed  Google Scholar 

  48. Yasunobu Y, Oudiz RJ, Sun X-G, Hansen JE, Wasserman K. End-tidal PCO2 abnormality and exercise limitation in patients with primary pulmonary hypertension. Chest. 2005;127:1637–46.

    PubMed  Google Scholar 

  49. Markowitz DH, Systrom DM. Diagnosis of pulmonary vascular limit to exercise by cardiopulmonary exercise testing. J Heart Lung Transplant. 2004;23:88–95.

    PubMed  Google Scholar 

  50. Weatherald J, Sattler C, Garcia G, Laveneziana P. Ventilatory response to exercise in cardiopulmonary disease: the role of Chemosensitivity and dead space. Eur Respir J. 2018;51:1700860.

    PubMed  Google Scholar 

  51. Velez-Roa S, Ciarka A, Najem B, Vachiery J-L, Naeije R, van de Borne P. Increased sympathetic nerve activity in pulmonary artery hypertension. Circulation. 2004;110:1308–12.

    PubMed  Google Scholar 

  52. Naeije R, van de Borne P. Clinical relevance of autonomic nervous system disturbances in pulmonary arterial hypertension. Eur Respir J. 2009;34:792–4.

    CAS  PubMed  Google Scholar 

  53. Wensel R, Jilek C, Dörr M, et al. Impaired cardiac autonomic control relates to disease severity in pulmonary hypertension. Eur Respir J. 2009;34:895–901.

    CAS  PubMed  Google Scholar 

  54. Hoeper MM, Pletz MW, Golpon H, Welte T. Prognostic value of blood gas analyses in patients with idiopathic pulmonary arterial hypertension. Eur Respir J. 2007;29:944–50.

    CAS  PubMed  Google Scholar 

  55. Weatherald J, Sattler C, Boucly A, et al. Chemosensitivity and ventilatory inefficiency in pulmonary vascular diseases. Eur Respir J. 2017;50:1966.

    Google Scholar 

  56. Jones PW, Huszczuk A, Wasserman K. Cardiac output as a controller of ventilation through changes in right ventricular load. J Appl Physiol. 1982;53:218–24.

    CAS  PubMed  Google Scholar 

  57. Ciarka A, Doan V, Velez-Roa S, Naeije R, van de Borne P. Prognostic significance of sympathetic nervous system activation in pulmonary arterial hypertension. Am J Respir Crit Care Med. 2010;181:1269–75.

    PubMed  Google Scholar 

  58. Dimopoulos S, Anastasiou-Nana M, Katsaros F, et al. Impairment of autonomic nervous system activity in patients with pulmonary arterial hypertension: a case control study. J Card Fail. 2009;15:882–9.

    PubMed  Google Scholar 

  59. Ponikowski PP, Chua TP, Francis DP, Capucci A, Coats AJ, Piepoli MF. Muscle ergoreceptor overactivity reflects deterioration in clinical status and cardiorespiratory reflex control in chronic heart failure. Circulation. 2001;104:2324–30.

    CAS  PubMed  Google Scholar 

  60. Sun X-G, Hansen JE, Oudiz RJ, Wasserman K. Gas exchange detection of exercise-induced right-to-left shunt in patients with primary pulmonary hypertension. Circulation. 2002;105:54–60.

    PubMed  Google Scholar 

  61. Chua TP, Clark AL, Amadi AA, Coats AJ. Relation between chemosensitivity and the ventilatory response to exercise in chronic heart failure. J Am Coll Cardiol. 1996;27:650–7.

    CAS  PubMed  Google Scholar 

  62. Scott AC, Wensel R, Davos CH, et al. Skeletal muscle reflex in heart failure patients: role of hydrogen. Circulation. 2003;107:300–6.

    CAS  PubMed  Google Scholar 

  63. Ciarka A, Vachièry J-L, Houssière A, et al. Atrial septostomy decreases sympathetic overactivity in pulmonary arterial hypertension. Chest. 2007;131:1831–7.

    PubMed  Google Scholar 

  64. Deboeck G, Scoditti C, Huez S, et al. Exercise testing to predict outcome in idiopathic versus associated pulmonary arterial hypertension. Eur Respir J. 2012;40:1410–9.

    PubMed  Google Scholar 

  65. Schwaiblmair M, Faul C, von Scheidt W, Berghaus TM. Ventilatory efficiency testing as prognostic value in patients with pulmonary hypertension. BMC Pulm Med. 2012;12:23.

    PubMed  PubMed Central  Google Scholar 

  66. Scheidl SJ, Englisch C, Kovacs G, et al. Diagnosis of CTEPH versus IPAH using capillary to end-tidal carbon dioxide gradients. Eur Respir J. 2012;39:119–24.

    CAS  PubMed  Google Scholar 

  67. Held M, Grün M, Holl R, et al. Cardiopulmonary exercise testing to detect chronic thromboembolic pulmonary hypertension in patients with normal echocardiography. Respiration. 2014;87:379–87.

    PubMed  Google Scholar 

  68. Laveneziana P, Montani D, Dorfmüller P, et al. Mechanisms of exertional dyspnoea in pulmonary veno-occlusive disease with EIF2AK4 mutations. Eur Respir J. 2014;44:1069–72.

    PubMed  Google Scholar 

  69. Wasserman K, Zhang YY, Gitt A, et al. Lung function and exercise gas exchange in chronic heart failure. Circulation. 1997;96:2221–7.

    CAS  PubMed  Google Scholar 

  70. Houstis NE, Eisman AS, Pappagianopoulos PP, et al. Exercise intolerance in HFpEF: diagnosing and ranking its causes using personalized O2 pathway analysis. Circulation. 2018;137:148–61.

    PubMed  Google Scholar 

  71. Van Iterson EH, Johnson BD, Borlaug BA, Olson TP. Physiological dead space and arterial carbon dioxide contributions to exercise ventilatory inefficiency in patients with reduced or preserved ejection fraction heart failure. Eur J Heart Fail. 2017;19:1675–85.

    PubMed  PubMed Central  Google Scholar 

  72. Dantzker DR, D’Alonzo GE, Bower JS, Popat K, Crevey BJ. Pulmonary gas exchange during exercise in patients with chronic obliterative pulmonary hypertension. Am Rev Respir Dis. 1984;130:412–6.

    CAS  PubMed  Google Scholar 

  73. Wagner PD. The physiological basis of pulmonary gas exchange: implications for clinical interpretation of arterial blood gases. Eur Respir J. 2015;45:227–43.

    CAS  PubMed  Google Scholar 

  74. Oudiz RJ, Midde R, Hovenesyan A, et al. Usefulness of right-to-left shunting and poor exercise gas exchange for predicting prognosis in patients with pulmonary arterial hypertension. Am J Cardiol. 2010;105:1186–91.

    PubMed  PubMed Central  Google Scholar 

  75. Jones NL, Robertson DG, Kane JW. Difference between end-tidal and arterial PCO2 in exercise. J Appl Physiol. 1979;47:954–60.

    CAS  PubMed  Google Scholar 

  76. Liu Z, Vargas F, Stansbury D, Sasse SA, Light RW. Comparison of the end-tidal arterial PCO2 gradient during exercise in normal subjects and in patients with severe COPD. Chest. 1995;107:1218–24.

    CAS  PubMed  Google Scholar 

  77. Esposito F, Mathieu-Costello O, Shabetai R, Wagner PD, Richardson RS. Limited maximal exercise capacity in patients with chronic heart failure: partitioning the contributors. J Am Coll Cardiol. 2010;55:1945–54.

    PubMed  PubMed Central  Google Scholar 

  78. Dimopoulos S, Tzanis G, Manetos C, et al. Peripheral muscle microcirculatory alterations in patients with pulmonary arterial hypertension: a pilot study. Respir Care. 2013;58:2134–41.

    PubMed  Google Scholar 

  79. Tolle J, Waxman A, Systrom D. Impaired systemic oxygen extraction at maximum exercise in pulmonary hypertension. Med Sci Sports Exerc. 2008;40:3–8.

    CAS  PubMed  Google Scholar 

  80. Bauer R, Dehnert C, Schoene P, et al. Skeletal muscle dysfunction in patients with idiopathic pulmonary arterial hypertension. Respir Med. 2007;101:2366–9.

    PubMed  Google Scholar 

  81. Duscha BD, Robbins JL, Jones WS, et al. Angiogenesis in skeletal muscle precede improvements in peak oxygen uptake in peripheral artery disease patients. Arterioscler Thromb Vasc Biol. 2011;31:2742–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  82. Esposito F, Reese V, Shabetai R, Wagner PD, Richardson RS. Isolated quadriceps training increases maximal exercise capacity in chronic heart failure: the role of skeletal muscle convective and diffusive oxygen transport. J Am Coll Cardiol. 2011;58:1353–62.

    PubMed  PubMed Central  Google Scholar 

  83. 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;114:1482–9.

    PubMed  Google Scholar 

  84. Ehlken N, Lichtblau M, Klose H, et al. Exercise training improves peak oxygen consumption and haemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thrombo-embolic pulmonary hypertension: a prospective, randomized, controlled trial. Eur Heart J. 2016;37:35–44.

    PubMed  Google Scholar 

  85. Puente-Maestu L, Palange P, Casaburi R, et al. Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement. Eur Respir J. 2016;47:429–60.

    PubMed  Google Scholar 

  86. Groepenhoff H, Vonk-Noordegraaf A, van de Veerdonk MC, Boonstra A, Westerhof N, Bogaard HJ. Prognostic relevance of changes in exercise test variables in pulmonary arterial hypertension. PLoS One. 2013;8:e72013.

    CAS  PubMed  PubMed Central  Google Scholar 

  87. Wensel R, Francis DP, Meyer FJ, et al. Incremental prognostic value of cardiopulmonary exercise testing and resting haemodynamics in pulmonary arterial hypertension. Int J Cardiol. 2013;167:1193–8.

    PubMed  Google Scholar 

  88. Badagliacca R, Papa S, Valli G, et al. Echocardiography combined with cardiopulmonary exercise testing for the prediction of outcome in idiopathic pulmonary arterial hypertension. Chest. 2016;150:1313–22.

    PubMed  Google Scholar 

  89. Barst RJ, McGoon M, McLaughlin V, et al. Beraprost therapy for pulmonary arterial hypertension. J Am Coll Cardiol. 2003;41:2119–25.

    CAS  PubMed  Google Scholar 

  90. Barst RJ, Langleben D, Frost A, et al. Sitaxsentan therapy for pulmonary arterial hypertension. Am J Respir Crit Care Med. 2004;169:441–7.

    PubMed  Google Scholar 

  91. Tang Y, Yao L, Liu Z, et al. Effect of calcium channel blockers evaluated by cardiopulmonary exercise testing in idiopathic pulmonary arterial hypertension responding to acute pulmonary vasoreactivity testing. Pulm Pharmacol Ther. 2017;43:26–31.

    CAS  PubMed  Google Scholar 

  92. Oudiz RJ, Roveran G, Hansen JE, Sun X-G, Wasserman K. Effect of sildenafil on ventilatory efficiency and exercise tolerance in pulmonary hypertension. Eur J Heart Fail. 2007;9:917–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  93. Wax D, Garofano R, Barst RJ. Effects of long-term infusion of prostacyclin on exercise performance in patients with primary pulmonary hypertension. Chest. 1999;116:914–20.

    CAS  PubMed  Google Scholar 

  94. Weatherald J, Boucly A, Chemla D, et al. The prognostic value of follow-up hemodynamic variables after initial management in pulmonary arterial hypertension. Circulation. 2018;137:693–704.

    PubMed  Google Scholar 

  95. Surie S, van der Plas MN, Marcus JT, et al. Effect of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension on stroke volume response to exercise. Am J Cardiol. 2014;114:136–40.

    PubMed  Google Scholar 

  96. Taboada D, Pepke-Zaba J, Jenkins DP, et al. Outcome of pulmonary endarterectomy in symptomatic chronic thromboembolic disease. Eur Respir J. 2014;44:1635–45.

    PubMed  Google Scholar 

  97. Claessen G, La Gerche A, Dymarkowski S, Claus P, Delcroix M, Heidbuchel H. Pulmonary vascular and right ventricular reserve in patients with normalized resting hemodynamics after pulmonary endarterectomy. J Am Heart Assoc. 2015;4:e001602.

    PubMed  PubMed Central  Google Scholar 

  98. Richter MJ, Sommer N, Gall H, et al. Pulmonary hemodynamic response to exercise in chronic thromboembolic pulmonary hypertension before and after pulmonary endarterectomy. Respiration. 2015;90:63–73.

    PubMed  Google Scholar 

  99. Bonderman D, Martischnig AM, Vonbank K, et al. Right ventricular load at exercise is a cause of persistent exercise limitation in patients with normal resting pulmonary vascular resistance after pulmonary endarterectomy. Chest. 2011;139:122–7.

    PubMed  Google Scholar 

  100. Delcroix M, Lang I, Pepke-Zaba J, et al. Long-term outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry. Circulation. 2016;133:859–71.

    CAS  PubMed  Google Scholar 

  101. Iwase T, Nagaya N, Ando M, et al. Acute and chronic effects of surgical thromboendarterectomy on exercise capacity and ventilatory efficiency in patients with chronic thromboembolic pulmonary hypertension. Heart. 2001;86:188–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  102. Charalampopoulos A, Gibbs JSR, Davies RJ, et al. Exercise physiological responses to drug treatments in chronic thromboembolic pulmonary hypertension. J Appl Physiol (1985). 2016;121:623–8.

    CAS  Google Scholar 

  103. Lang I, Meyer BC, Ogo T, et al. Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension. Eur Respir Rev. 2017;26:160119.

    PubMed  Google Scholar 

  104. Inami T, Kataoka M, Yanagisawa R, et al. Long-term outcomes after percutaneous transluminal pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Circulation. 2016;134:2030–2.

    PubMed  Google Scholar 

  105. Fukui S, Ogo T, Goto Y, et al. Exercise intolerance and ventilatory inefficiency improve early after balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension. Int J Cardiol. 2015;180:66–8.

    PubMed  Google Scholar 

  106. Fukui S, Ogo T, Morita Y, et al. Right ventricular reverse remodelling after balloon pulmonary angioplasty. Eur Respir J. 2014;43:1394–402.

    PubMed  Google Scholar 

  107. Andreassen AK, Ragnarsson A, Gude E, Geiran O, Andersen R. Balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension. Heart. 2013;99:1415–20.

    PubMed  Google Scholar 

  108. Akizuki M, Serizawa N, Ueno A, Adachi T, Hagiwara N. Effect of balloon pulmonary angioplasty on respiratory function in patients with chronic thromboembolic pulmonary hypertension. Chest. 2017;151:643–9.

    PubMed  Google Scholar 

  109. Ulrich S, Hasler ED, Saxer S, et al. Effect of breathing oxygen-enriched air on exercise performance in patients with precapillary pulmonary hypertension: randomized, sham-controlled cross-over trial. Eur Heart J. 2017;38:1159–68.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Sorbonne Université, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France

    Pierantonio Laveneziana

  2. AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l’Exercice et de la Dyspnée du Département “R3S”, Paris, France

    Pierantonio Laveneziana

  3. Faculté de médecine, Université Laval, Québec, QC, Canada

    Louis Laviolette

  4. Centre de recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec (CRIUCPQ), Québec, QC, Canada

    Louis Laviolette

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  1. Pierantonio Laveneziana
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Correspondence to Pierantonio Laveneziana .

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Editors and Affiliations

  1. Centre for Exercise and Sport Science, University of Ferrara, Ferrara, Italy

    Annalisa Cogo

  2. National Heart and Lung Institute, Imperial College London, London, UK

    Matteo Bonini

  3. Internal medicine Department, Ospedale Civile di Alghero, ASSL Sassari, ATS Sardegna, Alghero, Italy

    Paolo Onorati

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Laveneziana, P., Laviolette, L. (2019). Exercise in Pulmonary Vascular Diseases. In: Cogo, A., Bonini, M., Onorati, P. (eds) Exercise and Sports Pulmonology. Springer, Cham. https://doi.org/10.1007/978-3-030-05258-4_8

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