The Effect of Pulmonary Hypertension on Aerobic Exercise Capacity in Lung Transplant Candidates with Advanced Emphysema

Purpose: Mild pulmonary hypertension (PH) in patients with advanced COPD is common, but its effects on exercise capacity are controversial. The objective of our study was to investigate the effects of mild PH (35 > mPAP ≥ 25 mmHg) on exercise capacity in patients with advanced emphysema, candidates for lung transplantation. Methods: We retrospectively reviewed and compare the data from right heart catheterization and cardiopulmonary exercise test, performed in patients with advanced emphysema, candidate for lung transplantation. Results: Twenty patients with emphysema and no PH and 24 patients with emphysema associated with mild PH included in the study. Both patient groups had severe airways obstruction with markedly reduced FEV1 (24.9 % P ± 8.9 and 25.9 % P ± 11.7, respectively), and severely reduced DLCO (35.2 % P ± 17.3 and 39.2 % P ± 15.9). Both patients group demonstrated mark reduction in maximum workload and peak VO₂ together with increased ventilatory equivalent for CO₂ and extremely low breathing reserve. There was no correlation between mPAP and any of the exercise measurement. Conclusions: Our study suggests that exercise capacity in patients with advanced emphysema is limited by the ventilatory impairment and the presence of mild PH has no farther impact on exercise capability.