An observational analysis of exercise capacity in CTEPH patients after pulmonary endarterectomy

Introduction: Although pulmonary endarterectomy (PEA) in chronic thromboembolic pulmonary hypertension (CTEPH) is a highly effective treatment with significant improvements in hemodynamics and right ventricular function, persistent exercise limitation is frequent with many unknowns regarding its mechanisms. Aims: In an observational analysis we aimed to analyze the changes in exercise parameters post-PEA and identify persistent exercise pathology typical for CTEPH. Methods: We analyzed 68 CTEPH patients with cardiopulmonary exercise testing 6 months post-PEA. Results: 6 months post-PEA max load and peakVO2 significantly improved compared to baseline; circulatory and gas exchange parameters (O2 pulse, PETCO2, VE/VCO2, SpO2) improved, while ventilatory parameters remained unchanged. 42/68 (62%) had persistent exercise limitation 6 months post-PEA (peakVO2 Conclusions: In 68 CTEPH patients exercise capacity significantly improved after PEA; improvements were mainly in the circulatory and gas exchange domain. Persistent exercise limitation was frequent and mainly due to cardiocirculatory pathology. Signs typical of pulmonary vascular limitation during exercise were frequent after PEA in CTEPH.