Outpatient Point-of-Care Cardiopulmonary Exercise Testing in Chronic Thromboembolic Pulmonary Disease

BACKGROUND: Pulmonary vascular obstruction causes dyspnea in chronic thromboembolic pulmonary disease (CTEPD) and chronic thromboembolic pulmonary hypertension (CTEPH). Conventional assessments, like 6-minute walk test (6MWT) and World Health Organization (WHO) functional class (WHO-FC), poorly discriminate the mechanism of dyspnea. Cardiopulmonary exercise testing (CPET) offers direct evaluation of ventilatory efficiency and gas-exchange abnormalities. OBJECTIVES: The purpose of this study was to evaluate the impact of balloon pulmonary angioplasty (BPA) and pulmonary thromboendarterectomy (PTE) on CPET-derived gas-exchange parameters. METHODS: (minute ventilation/carbon dioxide production) slope. Secondary endpoints included changes in WHO-FC and 6MWT. RESULTS: and Shape-HF Severity Score positively correlated (P < 0.001), but not with 6MWT (P = 0.83). Before and after revascularization, the Shape-HF score improved in the BPA (2.4 vs 1.5; P < 0.001) and the PTE (2.3 vs 1.6; P = 0.01) groups. Survival at 1-year follow-up was a 100%. CONCLUSIONS: Point-of-care CPET provides objective assessment of gas-exchange improvements after pulmonary revascularization in mild-to-moderate CTEPH/CTEPD.