Exercise intolerance in pulmonary arterial hypertension: insight into central and peripheral pathophysiological mechanisms. (14th April 2021)

• Record Type: Journal Article
• Authors: Malenfant, Simon; Lebret, Marius; Breton-Gagnon, Émilie; Potus, François; Paulin, Roxane; Bonnet, Sébastien; Provencher, Steeve
• Is Part Of: European respiratory review. Volume 30:Number 160(2021)
• Publication Date: 2021-04-14
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases; Respiratory organs -- Diseases; Respiratory organs -- Diseases -- Treatment; Electronic journals; Periodical; Periodicals; Periodicals; 616.2
• DOI: 10.1183/16000617.0284-2020
• Languages: English
• ISSNs: 0905-9180

Abstract

Exercise intolerance is a cardinal symptom of pulmonary arterial hypertension (PAH) and strongly impacts patients' quality of life (QoL). Although central cardiopulmonary impairments limit peak oxygen consumption ( V′ O2peak ) in patients with PAH, several peripheral abnormalities have been described over the recent decade as key determinants in exercise intolerance, including impaired skeletal muscle (SKM) morphology, convective O2 transport, capillarity and metabolism indicating that peripheral abnormalities play a greater role in limiting exercise capacity than previously thought. More recently, cerebrovascular alterations potentially contributing to exercise intolerance in patients with PAH were also documented. Currently, only cardiopulmonary rehabilitation has been shown to efficiently improve the peripheral components of exercise intolerance in patients with PAH. However, more extensive studies are needed to identify targeted interventions that would ultimately improve patients' exercise tolerance and QoL. The present review offers a broad and comprehensive analysis of the present literature about the complex mechanisms and their interactions limiting exercise in patients and suggests several gaps in knowledge that need to be addressed in the future for a better understanding of exercise intolerance in patients with PAH. Cardiorespiratory, cerebrovascular and skeletal muscle (impaired skeletal muscle morphology, convective O2 transport, capillarity and metabolism) dysfunctions contribute symbiotically to reduce exercise capacity in patients with PAH https://bit.ly/3hOQxJB