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Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging

AIM: Human Immunodeficiency Virus (HIV) patients commonly experience dyspnea for which an immediate cause may not be always apparent. In this prospective cohort study of HIV patients with exercise limitation, we use cardiopulmonary exercise testing (CPET) coupled with exercise cardiovascular magneti...

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Autores principales: Patterson, Andrew J., Sarode, Anuja, Al-Kindi, Sadeer, Shaver, Lauren, Thomas, Rahul, Watson, Evelyn, Alaiti, Mohamad Amer, Liu, Yuchi, Hamilton, Jessie, Seiberlich, Nicole, Rashid, Imran, Gilkeson, Robert, Schilz, Robert, Hoit, Brian, Jenkins, Trevor, Zullo, Melissa, Bossone, Eduardo, Longenecker, Christopher, Simonetti, Orlando, Rajagopalan, Sanjay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549205/
https://www.ncbi.nlm.nih.gov/pubmed/33040733
http://dx.doi.org/10.1186/s12968-020-00664-6
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author Patterson, Andrew J.
Sarode, Anuja
Al-Kindi, Sadeer
Shaver, Lauren
Thomas, Rahul
Watson, Evelyn
Alaiti, Mohamad Amer
Liu, Yuchi
Hamilton, Jessie
Seiberlich, Nicole
Rashid, Imran
Gilkeson, Robert
Schilz, Robert
Hoit, Brian
Jenkins, Trevor
Zullo, Melissa
Bossone, Eduardo
Longenecker, Christopher
Simonetti, Orlando
Rajagopalan, Sanjay
author_facet Patterson, Andrew J.
Sarode, Anuja
Al-Kindi, Sadeer
Shaver, Lauren
Thomas, Rahul
Watson, Evelyn
Alaiti, Mohamad Amer
Liu, Yuchi
Hamilton, Jessie
Seiberlich, Nicole
Rashid, Imran
Gilkeson, Robert
Schilz, Robert
Hoit, Brian
Jenkins, Trevor
Zullo, Melissa
Bossone, Eduardo
Longenecker, Christopher
Simonetti, Orlando
Rajagopalan, Sanjay
author_sort Patterson, Andrew J.
collection PubMed
description AIM: Human Immunodeficiency Virus (HIV) patients commonly experience dyspnea for which an immediate cause may not be always apparent. In this prospective cohort study of HIV patients with exercise limitation, we use cardiopulmonary exercise testing (CPET) coupled with exercise cardiovascular magnetic resonance (CMR) to elucidate etiologies of dyspnea. METHODS AND RESULTS: Thirty-four HIV patients on antiretroviral therapy with dyspnea and exercise limitation (49.7 years, 65% male, mean absolute CD4 count 700) underwent comprehensive evaluation with combined rest and maximal exercise treadmill CMR and CPET. The overall mean oxygen consumption (VO(2)) peak was reduced at 23.2 ± 6.9 ml/kg/min with 20 patients (58.8% of overall cohort) achieving a respiratory exchange ratio > 1. The ventilatory efficiency (VE)/VCO(2) slope was elevated at 36 ± 7.92, while ventilatory reserve (VE: maximal voluntary ventilation (MVV)) was within normal limits. The mean absolute right ventricular (RV) and left ventricular (LV) contractile reserves were preserved at 9.0% ± 11.2 and 9.4% ± 9.4, respectively. The average resting and post-exercise mean average pulmonary artery velocities were 12.2 ± 3.9 cm/s and 18.9 ± 8.3 respectively, which suggested lack of exercise induced pulmonary artery hypertension (PAH). LV but not RV delayed enhancement were identified in five patients. Correlation analysis found no relationship between peak VO(2) measures of contractile RV or LV reserve, but LV and RV stroke volume correlated with PET CO(2) (p = 0.02, p = 0.03). CONCLUSION: Well treated patients with HIV appear to have conserved RV and LV function, contractile reserve and no evidence of exercise induced PAH. However, we found evidence of impaired ventilation suggesting a non-cardiopulmonary etiology for dyspnea.
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spelling pubmed-75492052020-10-13 Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging Patterson, Andrew J. Sarode, Anuja Al-Kindi, Sadeer Shaver, Lauren Thomas, Rahul Watson, Evelyn Alaiti, Mohamad Amer Liu, Yuchi Hamilton, Jessie Seiberlich, Nicole Rashid, Imran Gilkeson, Robert Schilz, Robert Hoit, Brian Jenkins, Trevor Zullo, Melissa Bossone, Eduardo Longenecker, Christopher Simonetti, Orlando Rajagopalan, Sanjay J Cardiovasc Magn Reson Research AIM: Human Immunodeficiency Virus (HIV) patients commonly experience dyspnea for which an immediate cause may not be always apparent. In this prospective cohort study of HIV patients with exercise limitation, we use cardiopulmonary exercise testing (CPET) coupled with exercise cardiovascular magnetic resonance (CMR) to elucidate etiologies of dyspnea. METHODS AND RESULTS: Thirty-four HIV patients on antiretroviral therapy with dyspnea and exercise limitation (49.7 years, 65% male, mean absolute CD4 count 700) underwent comprehensive evaluation with combined rest and maximal exercise treadmill CMR and CPET. The overall mean oxygen consumption (VO(2)) peak was reduced at 23.2 ± 6.9 ml/kg/min with 20 patients (58.8% of overall cohort) achieving a respiratory exchange ratio > 1. The ventilatory efficiency (VE)/VCO(2) slope was elevated at 36 ± 7.92, while ventilatory reserve (VE: maximal voluntary ventilation (MVV)) was within normal limits. The mean absolute right ventricular (RV) and left ventricular (LV) contractile reserves were preserved at 9.0% ± 11.2 and 9.4% ± 9.4, respectively. The average resting and post-exercise mean average pulmonary artery velocities were 12.2 ± 3.9 cm/s and 18.9 ± 8.3 respectively, which suggested lack of exercise induced pulmonary artery hypertension (PAH). LV but not RV delayed enhancement were identified in five patients. Correlation analysis found no relationship between peak VO(2) measures of contractile RV or LV reserve, but LV and RV stroke volume correlated with PET CO(2) (p = 0.02, p = 0.03). CONCLUSION: Well treated patients with HIV appear to have conserved RV and LV function, contractile reserve and no evidence of exercise induced PAH. However, we found evidence of impaired ventilation suggesting a non-cardiopulmonary etiology for dyspnea. BioMed Central 2020-10-12 /pmc/articles/PMC7549205/ /pubmed/33040733 http://dx.doi.org/10.1186/s12968-020-00664-6 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Patterson, Andrew J.
Sarode, Anuja
Al-Kindi, Sadeer
Shaver, Lauren
Thomas, Rahul
Watson, Evelyn
Alaiti, Mohamad Amer
Liu, Yuchi
Hamilton, Jessie
Seiberlich, Nicole
Rashid, Imran
Gilkeson, Robert
Schilz, Robert
Hoit, Brian
Jenkins, Trevor
Zullo, Melissa
Bossone, Eduardo
Longenecker, Christopher
Simonetti, Orlando
Rajagopalan, Sanjay
Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging
title Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging
title_full Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging
title_fullStr Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging
title_full_unstemmed Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging
title_short Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging
title_sort evaluation of dyspnea of unknown etiology in hiv patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549205/
https://www.ncbi.nlm.nih.gov/pubmed/33040733
http://dx.doi.org/10.1186/s12968-020-00664-6
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