Exercise capacity after pulmonary endoarterectomy and its determinants

Some patients with chronic thromboembolic pulmonary hypertension (CTEPH), despite successful pulmonary endoarterectomy (PEA), continue to suffer from exercise intolerance. This limitation may have multifactorial aetiology, including cardiac and respiratory factors, as well as deconditioning.The aim of this study is to assess the prevalence of patients with a limitation in exercise capacity at 12 months after PEA and its determinants. Treadmill incremental exercise test, spirometry, carbon monoxide transfer factor, arterial blood gas and right heart haemodynamic and echocardiographic examination were analysed in CTEPH patients who had undergone PEA at single centre. The treadmill exercise was performed according to the modified Bruce protocol and a reduced exercise capacity was defined as distance u003c or = 400 meters.Baseline and 1 year data were available in 155 of a group of 358 patients who had undergone PEA from 17/1/2008 and 31/12/2013 at the Pavia centre. Sixty out of 155 patients had a reduced exercise capacity.At the univariate analysis, age (continuous variable), gender (female), functional NYHA class (II or III) and increased pulmonary vascular resistance at 1 year after PEA were significantly (pu003c 0.05) associated with reduced exercise capacity.In conclusion, after successful PEA a consistent number of patients (39%) present a sustained limitation of exercise tolerance, which seems mainly due to pulmonary vascular factors.