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Vol. 47. Issue S7.
Hipertensión pulmonar
Pages 15-20 (November 2011)
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Vol. 47. Issue S7.
Hipertensión pulmonar
Pages 15-20 (November 2011)
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Prueba de esfuerzo cardiopulmonar en el manejo del paciente con hipertensión pulmonar
The cardiopulmonary exercise test in the management of patients with pulmonary hypertension
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Robert Naeijea, Isabel Blancob, Joan Albert Barberàb,c,??
Corresponding author
jbarbera@clinic.ub.es

Autor para correspondencia.
a Department of Pathophysiology, Erasme Hospital, Free University of Brussels, Bruselas, Bélgica
b Servicio de Neumología y Alergia Respiratoria, Institut Clínic del Tórax, Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, España
c Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), España
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La intolerancia al ejercicio es el principal síntoma de los pacientes con hipertensión pulmonar (HP). La prueba de referencia para la evaluación de la capacidad de ejercicio es la prueba de esfuerzo cardiopulmonar incremental (PECP) en cicloergómetro. La tolerancia al ejercicio en los pacientes con HP viene determinada principalmente por la capacidad de incrementar el gasto cardiaco a fin de atender las demandas metabólicas, que depende de la función del ventrículo derecho. Por ello, la disfunción ventricular derecha es el principal factor limitante de la tolerancia al esfuerzo en esta enfermedad. Los pacientes con HP también pueden presentar hipoxemia durante el ejercicio y es frecuente observar hiperventilación, tanto en reposo como durante el esfuerzo, que puede ser atribuible a una mayor quimiosensibilidad.

En la presente revisión se analizan los mecanismos fisiológicos que determinan la tolerancia al ejercicio, la respuesta al esfuerzo en los pacientes con HP y las variables de mayor interés para su estudio, las similitudes y diferencias entre la PECP y otras pruebas más sencillas, como la prueba de marcha de 6 minutos, y el valor pronóstico de las pruebas de esfuerzo en esta enfermedad. La valoración de la tolerancia al esfuerzo constituye un elemento esencial en la valoración clínica de los pacientes con HP, por lo que un conocimiento detallado de la información que pueden proporcionar las pruebas de esfuerzo y de sus limitaciones tiene indudable interés para el manejo clínico de esta compleja enfermedad.

Palabras clave:
Prueba de esfuerzo cardiopulmonar
Prueba de marcha de 6 minutos
Hipertensión arterial pulmonar
Consumo de oxígeno
Pulso de oxígeno
Equivalente ventilatorio
Abstract

The main symptom of patients with pulmonary hypertension (PH) is exercise intolerance. The gold standard for evaluation of exercise capacity is the incremental cardio-pulmonary exercise test (ICPET) on a bicycle ergometer. Exercise tolerance in patients with PH is mainly determined by the capacity to increase cardiac output to meet metabolic demands, which depends on right ventricular function. Therefore, right ventricular dysfunction is the main factor limiting exercise tolerance in PH. Patients with PH also show hypoxemia during exercise and hyperventilation is also common, both at rest and during exercise, which can be attributed to greater chemosensitivity.

The present review analyzes the physiological mechanisms determining exercise tolerance, exercise response in patients with PH, the variables of greatest interest in the study of this disorder, the similarities and differences between ICPET and other, simpler tests such as the 6-minute walk test, and the prognostic value of exercise testing in these patients. Evaluation of exercise tolerance is an essential element in the clinical assessment of patients with PH. Consequently, detailed knowledge of the information provided by exercise testing and its limitation is of undoubted interest in the clinical management of this complex disease.

Keywords:
Cardiopulmonary exercise test
6-minute walk test
Pulmonary hypertension
Oxygen consumption
Oxygen pulse
Ventilatory equivalent
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Copyright © 2011. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología

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