Exercise testing and risk assessment of pulmonary hypertension
Keywords:Exercise testing, Risk assessment, Pulmonary hypertension, PH management, Diagnostic tools
Managing pulmonary hypertension (PH) involves approaches to relieve symptoms, slow disease progression, and improve patient outcomes. Advances in treatment strategies, risk assessment methods, and lifestyle adjustments have significantly improved PH care. While PH has no cure, treatment options are available to alleviate symptoms, extend life expectancy, and slow disease advancement. Tailoring treatment strategies based on the type and severity of PH as individual patient response and tolerance is crucial. The main goals include alleviating symptoms, enhancing quality of life, improving capacity, and increasing survival rates. Diagnosis and management require evaluation and regular follow-up due to the complexity of PH treatments. Different medical approaches play a role in symptom relief. Improving overall system function. Oxygen therapy and procedures such as septostomy or lung transplantation may be warranted, contingent on disease severity. Lifestyle modifications, encompassing exercise training, smoking cessation, and weight management, complement pharmacological interventions. Risk assessment tools, typified by the REVEAL risk score, have revolutionized PH care by facilitating personalized therapeutic approaches. Genetic factors are increasingly considered, heralding a new era in tailored treatment. While challenges persist, ongoing research endeavors promise.
Forbes LM, Bull TM, Lahm T, Make BJ, Cornwell WK, 3rd. Exercise testing in the risk assessment of pulmonary hypertension. Chest. 2023;164(3):736-46.
Airhart SE, Insel M, Rischard F. Exercise pulmonary hypertension: What you need to know. American College of Cardiology. Available at: https://www. acc.org/Latest-in-Cardiology/Articles/ 2020/03/31/ 09/48/Exercise-Pulmonary-Hypertens ion#:~:text= Exercise%20pulmonary%20hypertension%20(PH)%20can,3%20mmHg%2FL%2Fmin.&text=Indexing%20of%20PAP%20to%20CO,increases%20in%20flow%20with%20exercise. Accessed on 09 July 2023.
European Society of Cardiology. ESC guidelines on Pulmonary Hypertension (diagnosis and treatment of). Available at: https://www.escardio.org/ Guidelines/Clinical-Practice-Guidelines/Pulmonary-Hypertension-Guidelines-on-Diagnosis-and-Treatment-of. Accessed on 09 July 2023.
Laveneziana P, Weatherald J. Pulmonary Vascular Disease and Cardiopulmonary Exercise Testing. Front Physiol. 2020;11.
May B. Transthoracic echocardiographic overestimates pulmonary arterial pressure in women with hypertension. 2020. Available at: https://www. pulmonologyadvisor.com/home/topics/pulmonary-hypertension/transthoracic-echocardiographic-overestimates-pulmonary-arterial-pressure-in-women-with-hypertension/. Accessed on 09 July 2023.
Stephan R, Ioana RP. Right heart catheterisation: best practice and pitfalls in pulmonary hypertension. Eur Resp Rev. 2015;24(138):642.
Pulmonary hypertension. Lancet Resp Med. 2023. Available at: https://www.thelancet.com/series/ pulmonary-hypertension-2023#:~:text=Karen%20 Olsson%20and%20colleagues%20consider,characterise%20pulmonary%20hypertension%20in%20this. Accessed on 09 July 2023.
Grossman J, Knox A, Pugliese SC. Right heart catheterization for pulmonary arterial hypertension: What to expect. 2022. Available at: https://www. myphteam.com/resources/what-to-know-about-right-heart-catheterization-and-pulmonary-hypertension. Accessed on 09 July 2023.
Nossaman BD, Scruggs BA, Nossaman VE, Murthy SN, Kadowitz PJ. History of right heart catheterization: 100 years of experimentation and methodology development. Cardiol Rev. 2010;18(2):94.
Richter MJ, Voswinckel R, Tiede H, Schulz R, Tanislav C, Feustel A, et al. Dynamic hyperinflation during exercise in patients with precapillary pulmonary hypertension. Resp Med. 2012;106(2):308-13.
Herdy AH, Ritt LE, Stein R, Araújo CG, Milani M, Meneghelo RS, et al. Cardiopulmonary Exercise Test: Background, Applicability and Interpretation. Arq Bras Cardiol. 2016;107(5):467-81.
MSN. Pulmonary hypertension. Available at: https://www.msn.com/en-us/health/condition/ Pulmonary-hypertension/hp-Pulmonary-hypertension?source=conditioncdx. Accessed on 09 July 2023.
Nauser TD, Stites SW. Diagnosis and treatment of pulmonary hypertension. Ame Fam Phys. 2001;63(9):1789-99.
Tartavoulle TM, Karpinski AC, Aubin A, Kluger BM, Distler O, Saketkoo LA. Multidimensional fatigue in pulmonary hypertension: prevalence, severity and predictors. ERJ Open Res. 2018;4(1).
Olshansky B, Feigofsky S. A Management Conundrum: Syncope in a Patient with Primary Pulmonary Hypertension. 2018. Available at: https://www.hmpgloballearningnetwork.com/site/eplab/articles/management-conundrum-syncope-patient-primary-pulmonary-hypotension. Accessed on 09 July 2023.
Paul C, Bruno D. Severe pulmonary arterial hypertension: treatment options and the bridge to transplantation. Eur Resp Rev. 2014;23(134):488.
Cassady SJ, Soldin D, Ramani GV. Novel and emerging therapies in pulmonary arterial hypertension. Front Drug Discovery. 2022;2.
Arumugham VB, Shahin MH. Therapeutic uses of diuretic agents. StatPearls Publishing. 2023.
Palmer M, Sutherland J, Barnard S, Wynne A, Rezel E, Doel A, et al. The effectiveness of smoking cessation, physical activity/diet and alcohol reduction interventions delivered by mobile phones for the prevention of non-communicable diseases: A systematic review of randomised controlled trials. PLoS One. 2018;13(1):e0189801.
Xanthouli P, Koegler M, Marra AM, Benjamin N, Fischer L, Eichstaedt CA, et al. Risk stratification and prognostic factors in patients with pulmonary arterial hypertension and comorbidities a cross-sectional cohort study with survival follow-up. Resp Res. 2020;21(1):127.
Patra JK, Das G, Fraceto LF, Campos EVR, Rodriguez-Torres MDP, Acosta-Torres LS, et al. Nano based drug delivery systems: recent developments and future prospects. J Nanobiotechnol. 2018;16(1):71.
Liu C, Chen J, Gao Y, Deng B, Liu K. Endothelin receptor antagonists for pulmonary arterial hypertension. Cochrane Database Syst Rev. 2013;2:Cd004434.