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Authors Chen TX, Pudasaini B, Guo J, Gong SG, Jiang R, Wang L, Zhao QH, Wu WH, Yuan P, Liu JM
Received 30 September 2017
Accepted for publication 4 December 2017
Published 26 January 2018 Volume 2018:13 Pages 385—397
DOI https://doi.org/10.2147/COPD.S152971
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Charles Downs
Peer reviewer comments 3
Editor who approved publication: Prof. Dr. Chunxue Bai
Background: Sex differences in chronic thromboembolic pulmonary hypertension
(CTEPH) have been revealed in few studies. Although right heart catheterization
(RHC) is the gold standard for clinical diagnosis and assessment of prognosis
in pulmonary hypertension (PH), cardiopulmonary exercise testing (CPET) has
been a more widely used assessment of functional capacity, disease severity,
prognosis, and treatment response in PH. We hypothesized that the
“sex-specific” CPET indices could estimate the severity of inoperable CTEPH.
Methods: Data were retrieved for 33 male (age, mean ±
standard deviation [SD] =62.5±13.4 years) and 40 female (age, mean ± SD
=56.3±11.8 years) patients with stable CTEPH who underwent both RHC and CPET at
Shanghai Pulmonary Hospital from February 2010 to February 2016. Univariate and
forward/backward multiple stepwise regression analysis was performed to assess
the predictive value of CPET indices to hemodynamic parameters. Event-free
survival was estimated using the Kaplan–Meier method and analyzed with the
log-rank test. Cox proportional hazards models were performed to determine the
independent event-free survival predictors.
Results: Numerous CPET parameters were different between male
and female patients with CTEPH and the control group. There were no significant
differences in both clinical variables and RHC parameters between male and
female patients with CTEPH. O2 pulse,
workload, minute ventilation (VE), and end-tidal partial pressure of O2 (PETO2) at anaerobic threshold, as well as peak O2 pulse, workload, VE, and nadir VE/CO2 were significantly higher in male patients
than in female patients (P <0.05). Only
oxygen uptake efficiency plateau (OUEP) showed a significantly higher
difference in female than male patients (P <0.05). In
addition, several CPET indices correlated with hemodynamic parameters,
especially pulmonary vascular resistance (PVR), which was distinctly different
between the sexes. Nadir VE/CO2 was an
independent predictor of PVR in male patients with CTEPH, whereas OUEP was an
independent predictor of PVR in female patients with CTEPH.
Conclusion: Even after confounding for age and body mass
index, different CPET measurements of gas exchange efficiency correlated with
PVR differently between male and female patients. This potentially could be
used to estimate the severity of CTEPH.
Keywords: sex difference,
chronic thromboembolic pulmonary hypertension, cardiopulmonary exercise
testing, severity