Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review

Kovàcs, Gabór; Berghold, Andrea; Scheidl, Stefan; Olschewski, Horst

doi:10.1183/09031936.00145608

Cited by 905 publications

(755 citation statements)

References 49 publications

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“…In addition, Condliffe and coworkers found that 19% of SSc patients with PAH who had exercise-induced PH developed resting PAH after ϳ2.3 years (19). Others, however, have argued that a certain degree of exerciseinduced PH may be explained by increasing age, persistent hypoxia, and/or systemic hypertension (22,23). Nonetheless, an exercise evaluation of SSc patients with PAH may allow for earlier diagnosis, initiation of therapy, and perhaps a more favorable outcome (24).…”

Section: Methodsmentioning

confidence: 99%

“…Disease duration was defined as the time since the first non-Raynaud's phenomenon sign or symptom attributable to SSc. We also explored the impact of older age (Ͼ50 years) (22) and significant ILD (FVC Ͻ60% predicted) (19) on exercise right heart catheterization hemodynamics.…”

Section: Methodsmentioning

confidence: 99%

“…In our study, normal patients were significantly younger than patients with eoPH and trended toward being younger than patients with ePVH and ePH; however, it remains unclear whether exercise-induced PH is an age-related phenomenon specifically in SSc. A recent systematic analysis suggested that during submaximal exercise, mPAP exceeds 30 mm Hg in 47% of all cases in normal, healthy adults age Ͼ50 years (22). However, measurements of PVR were not comprehensively reported.…”

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confidence: 99%

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Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

Saggar

Khanna

Fürst

et al. 2010

Arthritis & Rheumatism

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Objective. Exercise-induced pulmonary hypertension (PH) may represent an early but clinically relevant phase in the spectrum of pulmonary vascular disease. There are limited data on the prevalence of exerciseinduced PH determined by right heart catheterization in scleroderma spectrum disorders. We undertook this study to describe the hemodynamic response to exercise in a homogeneous population of patients with scleroderma spectrum disorders at risk of developing pulmonary vascular disease. Methods.Patients with normal resting hemodynamics underwent supine lower extremity exercise testing. A classification and regression tree (CART) analysis was used to assess combinations of variables collected during resting right heart catheterization that best predicted abnormal exercise physiology, applicable to each individual subject.Results. Fifty-seven patients who had normal resting hemodynamics underwent subsequent exercise right heart catheterization. Four distinct hemodynamic groups were identified during exercise: a normal group, an exercise-induced pulmonary venous hypertension (ePVH) group, an exercise out of proportion PH (eoPH) group, and an exercise-induced PH (ePH) group. The eoPH and ePVH groups had higher pulmonary capillary wedge pressure (PCWP) than the ePH group (P < 0.05). The normal and ePH groups had exercise PCWP <18 mm Hg, which was lower than that in the ePVH and eoPH groups (P < 0.05). During submaximal exercise, the transpulmonary gradient and pulmonary vascular resistance (PVR) were elevated in the ePH and eoPH groups as compared with the normal and ePVH groups (P < 0.05). CART analysis suggested that resting mean pulmonary artery pressure (mPAP) >14 mm Hg and PVR >160 dynes/seconds/cm ؊5 were associated with eoPH and ePH (positive predictive value 89% for mPAP 14-20 mm Hg and 100% for mPAP >20 mm Hg).Conclusion. We characterized the exercise hemodynamic response in at-risk patients with scleroderma spectrum disorders who did not have resting PH. Four distinct hemodynamic groups were identified during exercise. These groups may have potentially different prognoses and treatment options.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

Saggar

Khanna

Fürst

et al. 2010

Arthritis & Rheumatism

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“…The normal resting mean pulmonary artery pressure (PAP) is 14 mm Hg, with an upper limit (based on 2 SD) of 20.6 mm Hg and varies little with age (6). A mean PAP of Ն25 mm Hg at rest, measured at RHC, is required for a diagnosis of PH (7).…”

Section: (202 MM Hg) To Followup (243 Mm Hg) (P < 005 By Student'smentioning

confidence: 99%

Borderline Mean Pulmonary Artery Pressure in Patients With Systemic Sclerosis: Transpulmonary Gradient Predicts Risk of Developing Pulmonary Hypertension

Valerio¹,

Schreiber²,

Handler³

et al. 2013

Arthritis & Rheumatism

161

107

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Objective. To determine whether patients with systemic sclerosis (SSc) and borderline mean pulmonary artery pressure (PAP) at cardiac catheterization are more likely to develop pulmonary hypertension (PH) than those in whom pulmonary pressure is normal.Methods. Patients with SSc in whom PH and significant interstitial lung disease had been excluded at baseline were enrolled in our prospective cohort. Analysis of followup data identified patients who met prespecified criteria prompting repeat catheterization to reassess for possible PH. Using Kaplan-Meier, receiver operating characteristic, and Cox regression methods, we studied the development of PH and death.Results. Of 228 patients in this study, 86 had borderline mean PAP (21-24 mm Hg) at baseline. Following prespecified criteria, 76 patients underwent repeat catheterization, and 29 of these developed PH. Two cases were related to disease of the left side of the heart. The average mean PAP increased from baseline (20.2 mm Hg) to followup (24.3 mm Hg) (P < 0.05 by Student's t-test). Patients with borderline mean PAP were more likely to develop PH than patients with mean PAP <20 mm Hg (P < 0.001 by log rank test, hazard ratio [HR] 3.7). A transpulmonary gradient (TPG) >11 mm Hg at baseline also predicted PH (P < 0.001 by log rank test, HR 7.9). Incident development of pulmonary arterial hypertension (PAH) was not benign, with a mortality of 18% within 3 years.Conclusion. Our findings indicate that borderline mean PAP and an elevated TPG in patients with SSc predict progression to PH. These patients should be monitored closely for the development of PH. Our findings indicate that catheterization data are useful in patients considered at risk of PAH.

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“…Данные исследований свидетельствуют, что во время суб-максимальной ФН СрДЛА превосходит 30 мм рт.ст. у 47% всех здоровых пациентов старше 50 лет [17]. При этом ве-личина ЛСС не сообщается.…”

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Impact of bosentan therapy on stress-induced pulmonary hypertension in patients with scleroderma systematica

et al. 2015

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Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review

Cited by 905 publications

References 49 publications

Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

Borderline Mean Pulmonary Artery Pressure in Patients With Systemic Sclerosis: Transpulmonary Gradient Predicts Risk of Developing Pulmonary Hypertension

Impact of bosentan therapy on stress-induced pulmonary hypertension in patients with scleroderma systematica

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