A recent study conducted in China has found that individuals newly diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) who experience lower exercise capacity and ventilatory efficiency tend to report more severe symptoms of anxiety and depression. Researchers emphasized the importance of addressing psychological symptoms during the initial evaluation of CTEPH patients, especially those with significant functional limitations.
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The study, titled "Cross-sectional independent associations of anxiety and depressive symptoms with cardiopulmonary exercise performance in treatment-naïve chronic thromboembolic pulmonary hypertension," was published in the Journal of Psychosomatic Research. CTEPH occurs when abnormal blood clots obstruct or narrow blood vessels in the lungs, increasing pressure and reducing oxygen transport throughout the body, which can lead to shortness of breath and fatigue.
While previous research indicated a prevalence of psychological disorders among CTEPH patients, the link between the severity of these symptoms and exercise performance was not well explored. The researchers aimed to fill this gap by enrolling 236 untreated CTEPH patients, who underwent cardiopulmonary exercise testing, a six-minute walk test, right heart catheterization, and completed standardized questionnaires to assess anxiety and depression severity. Statistical analyses were performed to identify significant associations.
Findings revealed that anxiety and depressive symptoms were notably correlated with exercise capacity and ventilatory efficiency. Patients with greater physical limitations, who had to exert more effort to clear carbon dioxide during exercise, generally reported more severe anxiety and depression. Specifically, depressive symptoms were more broadly associated with exercise metrics compared to anxiety. Higher scores on depressive symptom assessments were linked to lower peak oxygen uptake (VO₂peak) and shorter walking distances during the six-minute test.
The research highlighted a potential bidirectional relationship between mental health and physical limitations in CTEPH. Increased shortness of breath and functional constraints may aggravate psychological symptoms, while anxiety and depression could negatively impact exercise performance through behavioral and physiological mechanisms. The researchers concluded that these findings underscore the need for careful attention to mental health during clinical assessments and serve as a foundation for future studies exploring the reciprocal relationship between psychological health and physical recovery.
The study was limited to a single time point for its Chinese patient cohort, which precluded any determination of causality. The authors recommended longitudinal studies to track changes in both mental health symptoms and exercise performance over time during and after treatment.