• Guilherme Casagrande de Almeida, Mônica Corso Pereira, Marcos Mello Moreira, José Roberto Matos Souza, and Ilma Aparecida Paschoal.
• PT, MSc. Physiotherapist and Professor, Department of Physical Therapy, Paulista University, Campinas (SP), Brazil.
• Sao Paulo Med J. 2021 Aug 1; 139 (5): 505-510.

BackgroundThe mechanism of exercise limitation in idiopathic pulmonary arterial hypertension (IPAH) is not fully understood. The role of hemodynamic alterations is well recognized, but mechanical, ventilatory and gasometric factors may also contribute to reduction of exercise capacity in these individuals.ObjectiveTo investigate whether there is an association between ventilatory pattern and stress Doppler echocardiography (SDE) variables in IPAH patients.Design And SettingSingle-center prospective study conducted in a Brazilian university hospital.MethodsWe included 14 stable IPAH patients and 14 age and sex-matched controls. Volumetric capnography (VCap), spirometry, six-minute walk test and SDE were performed on both the patients and the control subjects. Arterial blood gases were collected only from the patients. The IPAH patients and control subjects were compared with regard to the abovementioned variables.ResultsThe mean age of the patients was 38.4 years, and 78.6% were women. The patients showed hypocapnia, and in spirometry 42.9% presented forced vital capacity (FVC) below the lower limit of normality. In VCap, IPAH patients had higher respiratory rates (RR) and lower elimination of CO2 in each breath. There was a significant correlation between reduced FVC and the magnitude of increases in tricuspid regurgitation velocity (TRV). In IPAH patients, VCap showed similar tidal volumes and a higher RR, which at least partially explained the hypocapnia.ConclusionsThe patients with IPAH showed hypocapnia, probably related to their higher respiratory rate with preserved tidal volumes; FVC was reduced and this reduction was positively correlated with cardiac output.

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