evrazkarЕвразийский Кардиологический ЖурналEurasian heart journal2225-16852305-0748Евразийская ассоциация кардиологов10.38109/2225-1685-2017-4-86-99evrazkar-261Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL PAPERSСПИРОВЕЛОЭРГОМЕТРИЯ В СТРАТИФИКАЦИИ РИСКА ПАЦИЕНТОВ С ЛЕГОЧНОЙ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ И ХРОНИЧЕСКОЙ ТРОМБОЭМБОЛИЧЕСКОЙ ЛЕГОЧНОЙ ГИПЕРТЕНЗИЕЙCARDIOPULMONARY EXCERSISE TESTING IN RISK STRATIFICATION IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION AND CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSIONТаранИ. Н.TaranI. N.

Аспирант отдела легочной гипертензии и заболеваний сердца

121552, г. Москва, 3-я Черепковская, д. 15 а

тел.: 8-495-414-68-02

Postgraduate student of the department of pulmonary hypertension and heart diseases 

121552, Moscow, 3rd Street Cherepkovskaya, 15 a

tel.: 8-495-414-68-02

zaviirina@mail.ruВалиеваЗ. С.ValievaZ. S.

К.м.н., научный сотрудник отдела легочной гипертензии и заболеваний сердца 

121552, г. Москва, 3-я Черепковская, д. 15 а

тел.: 8-495-414-68-33

PhD, Researcher of the department of pulmonary hypertension and heart diseases 

121552, Moscow, 3rd Street Cherepkovskaya, 15 a

tel.: 8-495-414-68-33

v.zarina.v@gmail.comМартынюкТ. В.MartynyukT. V.

Д.м.н., руководитель отдела легочной гипертензии и заболеваний сердца 

121552, г. Москва, 3-я Черепковская, д. 15 а,

тел.: 8-495-414-64-50

MD, Head of the department of pulmonary hypertension and heart diseases 

121552, Moscow, 3rd Street Cherepkovskaya, 15 a

tel. 8-495-414-64-50

trukhiniv@mail.ruЧазоваИ. Е.ChazovaI. Ye.

Академик РАН, профессор, директор

121552, г. Москва, 3-я Черепковская, д. 15 а

тел.: 8-495-414-63-05

Academician of Russian Academy of Science, MD, Director 

121552, Moscow, 3rd Street Cherepkovskaya, 15 a

tel. 8-495-414-63-05

noemail@neicon.ruФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава РоссииРоссияNational Medical Research Center of cardiology of the Ministry of Health of the Russian FederationRussian FederationФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава РоссииРоссияNational Medical Research Centre of cardiology of Ministry of HealthRussian Federation201730122017048699Copyright © Таран И.Н., Валиева З.С., Мартынюк Т.В., Чазова И.Е., 20172017Таран И.Н., Валиева З.С., Мартынюк Т.В., Чазова И.Е.Taran I.N., Valieva Z.S., Martynyuk T.V., Chazova I.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.heartj.asia/jour/article/view/261

В последние годы накапливается все больше информации об актуальности использования спировелоэргометрии (СВЭМ) в рамках комплексного обследования пациентов с легочной артериальной гипертензией (ЛАГ) и хронической тромбоэмболической легочной гипертензией (ХТЭЛГ). Согласно рекомендациям Европейского Общества Кардиологов и Европейского Респираторного Общества по диагностике и лечению легочной гипертензии 2015 года параметры СВЭМ (пиковое потребление кислорода (Vo2 peak) и вентиляционный эквивалент углекислого газа (VE/Vco2)), являются важными компонентами шкалы стратификации риска летальности пациентов с ЛАГ в дополнение к тесту 6-минутной ходьбы, параметрам эхокардиографии, катетеризации правых отделов сердца, биохимическим маркерам. На настоящий момент у пациентов с ХТЭЛГ не существует определенных параметров стратификации риска летально го исхода в течение года, которые могут использоваться в клинической практике. Целью нашего исследования явилась оценка роли СВЭМ в стратификации риска развития летального исхода, оценке эффективности принимаемой патогенетической терапии и решении вопроса о необходимости эскалации терапии у пациентов с ЛАГ и ХТЭЛГ. Результаты исследования продемонстрировали, что данные, полученные с помощью СВЭМ, необходимы для комплексной оценки состояния пациента, играют важную роль в определении тактики лечения и являются неотъемлемыми компонентами шкалы стратификации риска летальности пациентов с ЛАГ, и, вероятно, могут применяться в клинической практике для стратификация риска летального исхода пациентов с ХТЭЛГ.

In recent years the information about relevance of cardiopulmonary exercise testing (CPET) in complex assessment of pulmonary arterial hypertension (PAH) patients and chronic thromboembolic pulmonary hypertension (CTEPH) patients have been accumulating. Parameters of CPET, such as peak oxygen consumption (Vo2 peak) and ventilation equivalents (VE/Vco2) are very important in risk stratification in patients with PAH, also as distance in 6-minute walking test, the echocardiography and right heart catheterization results, N-terminal prohormone of natriuretic peptide according to the European Society of Cardiology and European Respiratory Society guidelines on diagnosis and treatment of pulmonary hypertension. However, there are no parameters, which can be used in clinical practice to reflect the risk of mortality during 1 year in patients with CTEPH. The aim of our study was to assess the role of CPET in risk stratification, achieving therapy goals and making decision about therapy escalation in patients with PAH and CTEPH. Results of our pilot study demonstrated, that CPET parameters are the reliable markers to reflect the PAH and CTEPH progression. The CPET is necessary for pathogenic therapy efficacy assessment and for making decision of therapy escalation in patients with PAH, also as in CTEPH patients. The critical role of CPET in risk stratification in PAH and CTEPH patients should be emphasized.

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The authors declare that there are no conflicts of interest present.