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A Journal on Heart and Vascular Diseases
Official Journal of the Italian Society of Angiology and Vascular Pathology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,752
Minerva Cardioangiologica 2004 February;52(1):29-36
Cardiopulmonary exercise testing and exhaled nitric oxide in the assessment of patients with mitral stenosis
Omedè P., Bucca C., Rolla G., Costanzo P., Casoni R., Calachanis M., Morello M.,Mangiardi L., Trevi G. P.
Aim. In patients with mitral stenosis, symptoms do not always correlate with echocardiographic data. The aims of the study were to evaluate the role of cardiopulmonary exercise testing in the assessment of patients with mitral stenosis and to quantify nitric oxide production at rest and at the end of exercise.
Methods. We evaluated 43 patients with moderate to severe mitral stenosis with a discrepancy between echocardiographic data and symptoms. Nitric oxide output was calculated by measuring nitric oxide concentration in the exhaled air at rest and at the end of exercise test.
Results. Patients were divided in 2 groups: group 1 with a functional capacity <75% at cardiopulmonary exercise test (V.O2max in % of the predicted one) and group 2 with functional capacity >75%. Transvalvular gradient and pulmonary artery pressure were significantly higher in group 1 than in group 2 (respectively 9.07±2.11 mmHg vs 6.01±1.08 mmHg, p<0.001 and 42.8±7.2 mmHg vs 33.1±4.7 mmHg, p<0.001). Patients of group 1 had a lower nitric oxide output at the end of exercise compared to group 2 (231.4±96.6 nl/min vs 326.3±74.0 ml/min, p=0.01) and to normal subjects (511.15±180.1 nl/min, p<0.001).
Conclusion. Cardiopulmonary exercise testing provides objective non invasive information in the evaluation of patients with discrepancy between symptoms and echocardiographic data. Different levels of nitric oxide output during exercise suggest the role of nitric oxide in regulating pulmonary vascular tone.