Cardiovascular mechanisms of exercise intolerance in individuals with chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis
Notice bibliographique
Résumé
Abstract Background Reduced exercise tolerance – measured as decreased peak oxygen uptake (peak VO2) – is a hallmark feature of chronic thromboembolic pulmonary hypertension (CTEPH). However, the mechanisms underlying decreased peak VO2 in individuals with CTEPH are unclear. Purpose To evaluate the degree of impairment in peak VO2 and its underlying mechanisms in individuals with CTEPH versus healthy controls (CON). Methods A systematic search was conducted using PubMed (January 1993 to May 2023) for studies evaluating peak VO2 with or without additional evaluation of exercise hemodynamics in individuals with CTEPH and healthy controls. Studies were included if they met the following criteria: 1a) evaluation of peak VO2 from maximal cardiopulmonary testing with or without additional evaluation of exercise hemodynamics; 2) individuals with confirmed CTEPH; 3) ≥18 years of age 4) inclusion of a non-CTEPH healthy control group. A meta-analysis of included studies was performed, with values for CTEPH and CON compared using a fixed-effects model. Results (CTEPH vs CON) are reported as weighted mean differences (WMD) with 95% confidence interval (95% CI), with heterogeneity assessed using the I2 statistic. Results Of 286 studies identified in the initial search, nine studies met the inclusion criteria and were included in the meta-analysis, encompassing 189 individuals with CTEPH (mean age: 57 yrs) and 115 CON (mean age: 47 yrs). Peak VO2 was assessed during upright exercise in 8 studies, whilst hemodynamic assessments were performed during semi-supine exercise echocardiography in one study, or supine exercise cardiac magnetic resonance imaging in six studies. Peak VO2 (Figure 1A) was significantly lower in CTEPH vs CON (WMD: -13.8 mL/kg/min, 95% CI: -15.0 to -12.6; I2: 93%). This coincided with decreased maximal heart rate assessed during upright (WMD: -26 b/min, 95% CI: -31 to -21; I2: 81%) or supine exercise (WMD: -25 b/min, 95% CI: -28 to -21; I2: 0%), and a lower supine peak exercise stroke volume index (WMD: -25 mL/m2, 95% CI: -30 to -20; I2: 0%), resulting in a decreased supine peak cardiac index (WMD: -4.05 L/min/m2, 95% CI: 4.53 to -3.56; I2: 62%). Individuals with CTEPH also demonstrated substantial reduction in peak exercise right (RVEF, Figure 1B - WMD: -37.7%, 95% CI: -39.8 to -35.6; I2: 0%) and left-ventricular ejection fraction (LVEF, Figure 1C - WMD: -4.0%, 95% CI: -6.2 to -1.8; I2: 0%). In CTEPH, the average peak exercise RVEF was 34% lower than LVEF, indicative of adverse biventricular interaction that may be mediated by the exaggerated mean peak pulmonary artery pressures during exercise (+43 mmHg, 95% CI: 40 to 46; I2: 0%). Conclusion CTEPH is associated with a severely marked impairment in peak VO2 that is secondary to multifactorial impairments in cardiovascular function. This highlights the need for tailored, multi-component therapies aimed at addressing the complex pathophysiology driving exercise intolerance in CTEPH.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,022 | 0,008 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».