Cardiopulmonary Exercise Test Changes And Its Clinical Significance In Pulmonary Arterial Hypertension With Adult Congenital Atrial Septal Defect After Interventional Closure

Objective:To study the changes and clinical significance of cardiopulmonary exercise test in adult congenital atrial septal defect with pulmonary arterial hypertension before and after interventional closureMethods:To collect the second affiliated hospital of Nanchang university cardiovascular internal medicine the inpatient in June 2017 to January 2018 in heart heart international,Successfully performed Atrial septal defect?ASD?occlusion and 40patients who had complete CPET data before and after interventional closure.According to the mean pulmonary artery pressure into the three groups:congenital heart disease without pulmonary hypertension group?CHD-NPAH?14 cases;Congenital heart disease with lingt pulmonary hypertension group?CHD-LPAH?14cases;Congenital heart disease with moderate pulmonary hypertension?CHD-MPAH?12 patients.To collected relevant clinical data of the study subjects and performed right-heart catheterization?RHC?concurrently.Echocardiography?UCG?,6-minute walking test?6-MWT?,pulmonary function test?PFT?,and cardiopulmonary exercise test?CPET?were performed before and 3 months after interventional closure.And according to CPET,exercise prescriptions were given to patientsResults:?1?Preoperative patients with CHD-PAH?CHD-LPAH group,CHD-MPAH group?reduce in CPET?Peak-Load,Load at anaerobic threshold?Load@AT?,Peak oxygen uptake?Peak-VO₂?,Anaerobic threshold?AT?,Peak oxygen pulse?PeakO₂/HR?,oxygen pulse at anaerobic threshold?O₂/HR@AT??Peak minute ventilation?Peak-VE??minute ventilation at anaerobic threshold?VE@AT??,and obviously increased VE/VCO₂slope.the lung function of VC,FEV₁%,FEV₁/VC,MVV is reduced,the above index obviously patients with CHD-NPAH statistically significant?P<0.05?,the CHD-MPAH comparison with CHD-LPAH were difference,P<0.05,there was a significant statistical significance.?2?There was a negative correlation between pulmonary function?FVC,MVV?and Mean pulmonary artery pressure?MPAP??r=-0.773,r=-0.653,P<0.01?.Pulmonary function is Restrictive ventilation dysfunction.There was a negative correlation between CEPT?Peak-VO2,O2Pulse,Peak-VE,Peak-Load?and right heart catheterization parameters?MPAP??r=-0.809,r=-0.758,r=-0.720,r=-0.684,P<0.01?,positive correlation between VE/VCO₂ and right heart catheterization parameters?MPAP??r=0.538,P<0.01??3?6-MET of CHD patients increased slightly after surgery than before surgery,but it was not statistically significant?P>0.05?.CPET was found after sealing in CHD patients with Peak Load,Load@AT,PeakVO₂,AT,PeakVO₂/HR,VO₂/HR@AT,PeakVE,VE@AT were significantly higher than before surgery,and had statistically significant differences?P<0.01?;VE/VCO₂ was significantly lower than before surgery,and there was a statistical difference?P<0.01?.Peak-RER,Peak-SBP,Peak-DBP,Peak-HR,and HR@AT were also increased.but no statistical difference?P>0.05?.PFT?FVC,FEV₁%,FEV₁/FVC,MVV?were significantly higher than the before interventional occlusion parameter,that had statistical differences?P<0.01?.?4?According to the AT at three months after the occlusion,exercise prescriptions with moderate exercise intensity?AT*80%?were given and differences were found between the three groups.CHD-PAH was less than CHD-NPAH,and CHD-MPAH was less than CHD-LPAHConclusion:?1?.Cardiopulmonary function differs between patients with CHD-NPAH and patients with CHD-PAH.Peak-load and Peak-VO₂ in patients with CHD-PAH are lower than those in CHD-NPAH patients,VE/VCO₂ more than that.?2?.At three months after interventional occlusion,the patient's heart structure,CPET,and PFT indicators tend to improve.CPET may be better than 6-MWT in evaluating the exercise load of CHD-PAH patients after interventional occlusion,CPET can be a follow-up tool for exercise rehabilitation in patients with CHD-PAH after interventional occlusion.