Criteria for diagnosis of exercise pulmonary hypertension.
Identifieur interne : 002954 ( PubMed/Curation ); précédent : 002953; suivant : 002955Criteria for diagnosis of exercise pulmonary hypertension.
Auteurs : Philippe Herve [Oman] ; Edmund M. Lau [Australie] ; Olivier Sitbon [France] ; Laurent Savale [France] ; David Montani [France] ; Laurent Godinas [France] ; Frederic Lador [France] ; Xavier Jaïs [France] ; Florence Parent [France] ; Sven Günther [France] ; Marc Humbert [France] ; Gerald Simonneau [France] ; Denis Chemla [France]Source :
- The European respiratory journal [ 1399-3003 ] ; 2015.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Aire sous la courbe, Analyse de variance, Courbe ROC, Dysfonction ventriculaire gauche (diagnostic), Débit cardiaque (physiologie), Débit systolique, Espagne, Femelle, Humains, Hypertension pulmonaire (diagnostic), Hypertension pulmonaire (physiopathologie), Hémodynamique (physiologie), Mâle, Résistance vasculaire (physiologie), Sujet âgé, Valeurs de référence, Épreuve d'effort, Études cas-témoins, Études rétrospectives, Évaluation des risques.
- MESH :
- diagnostic : Dysfonction ventriculaire gauche, Hypertension pulmonaire.
- physiologie : Débit cardiaque, Hémodynamique, Résistance vasculaire.
- physiopathologie : Hypertension pulmonaire.
- Adulte, Adulte d'âge moyen, Aire sous la courbe, Analyse de variance, Courbe ROC, Débit systolique, Espagne, Femelle, Humains, Mâle, Sujet âgé, Valeurs de référence, Épreuve d'effort, Études cas-témoins, Études rétrospectives, Évaluation des risques.
- Wicri :
- geographic : Espagne.
English descriptors
- KwdEn :
- Adult, Aged, Analysis of Variance, Area Under Curve, Cardiac Output (physiology), Case-Control Studies, Exercise Test, Female, Hemodynamics (physiology), Humans, Hypertension, Pulmonary (diagnosis), Hypertension, Pulmonary (physiopathology), Male, Middle Aged, ROC Curve, Reference Values, Retrospective Studies, Risk Assessment, Spain, Stroke Volume, Vascular Resistance (physiology), Ventricular Dysfunction, Left (diagnosis).
- MESH :
- geographic : Spain.
- diagnosis : Hypertension, Pulmonary, Ventricular Dysfunction, Left.
- physiology : Cardiac Output, Hemodynamics, Vascular Resistance.
- physiopathology : Hypertension, Pulmonary.
- Adult, Aged, Analysis of Variance, Area Under Curve, Case-Control Studies, Exercise Test, Female, Humans, Male, Middle Aged, ROC Curve, Reference Values, Retrospective Studies, Risk Assessment, Stroke Volume.
Abstract
The previous definition of exercise pulmonary hypertension (PH) with a mean pulmonary artery pressure (mPAP) >30 mmHg was abandoned because healthy individuals can exceed this threshold at high cardiac output (CO). We hypothesised that incorporating assessment of the pressure-flow relationship using the mPAP/CO ratio, i.e. total pulmonary resistance (TPR), might enhance the accuracy of diagnosing an abnormal exercise haemodynamic response.Exercise haemodynamics were evaluated in 169 consecutive subjects with normal resting mPAP ≤20 mmHg. Subjects were classified into controls without heart or lung disease (n=68) versus patients with pulmonary vascular disease (PVD) (n=49) and left heart disease (LHD) (n=52).TPR and mPAP at maximal exercise produced diagnostic accuracy with area under the receiver operating curve of 0.99 and 0.95, respectively, for discriminating controls versus patients with PVD and LHD. The old criterion of mPAP >30 mmHg had sensitivity of 0.98 but specificity of 0.77. Combining maximal mPAP >30 mmHg and TPR >3 mmHg·min·L(-1) retained sensitivity at 0.93 but improved specificity to 1.0. The accuracy of the combined criteria was high across different age groups, sex, body mass index and diagnosis (PVD or LHD).Combining mPAP >30 mmHg and TPR >3 mmHg·min·L(-1) is superior to mPAP >30 mmHg alone for defining a pathological haemodynamic response of the pulmonary circulation during exercise.
DOI: 10.1183/09031936.00021915
PubMed: 26022955
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<author><name sortKey="Herve, Philippe" sort="Herve, Philippe" uniqKey="Herve P" first="Philippe" last="Herve">Philippe Herve</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Chirurgie Thoracique et Vasculaire et de Transplantation Cardio-Pulmonaire, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France herveccml@gmail.com.</nlm:affiliation>
<country wicri:rule="url">Oman</country>
<wicri:regionArea>Département de Chirurgie Thoracique et Vasculaire et de Transplantation Cardio-Pulmonaire, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson</wicri:regionArea>
</affiliation>
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<author><name sortKey="Lau, Edmund M" sort="Lau, Edmund M" uniqKey="Lau E" first="Edmund M" last="Lau">Edmund M. Lau</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France Sydney Medical School, University of Sydney, Camperdown, Australia.</nlm:affiliation>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France Sydney Medical School, University of Sydney, Camperdown</wicri:regionArea>
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<author><name sortKey="Sitbon, Olivier" sort="Sitbon, Olivier" uniqKey="Sitbon O" first="Olivier" last="Sitbon">Olivier Sitbon</name>
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<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Université Paris-Sud, Le Kremlin-Bicêtre</wicri:regionArea>
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<author><name sortKey="Savale, Laurent" sort="Savale, Laurent" uniqKey="Savale L" first="Laurent" last="Savale">Laurent Savale</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
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<author><name sortKey="Montani, David" sort="Montani, David" uniqKey="Montani D" first="David" last="Montani">David Montani</name>
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<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Université Paris-Sud, Le Kremlin-Bicêtre</wicri:regionArea>
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<author><name sortKey="Godinas, Laurent" sort="Godinas, Laurent" uniqKey="Godinas L" first="Laurent" last="Godinas">Laurent Godinas</name>
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<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson</wicri:regionArea>
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<author><name sortKey="Lador, Frederic" sort="Lador, Frederic" uniqKey="Lador F" first="Frederic" last="Lador">Frederic Lador</name>
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<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre</wicri:regionArea>
</affiliation>
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<author><name sortKey="Jais, Xavier" sort="Jais, Xavier" uniqKey="Jais X" first="Xavier" last="Jaïs">Xavier Jaïs</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson</wicri:regionArea>
</affiliation>
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<author><name sortKey="Parent, Florence" sort="Parent, Florence" uniqKey="Parent F" first="Florence" last="Parent">Florence Parent</name>
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<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson</wicri:regionArea>
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<author><name sortKey="Gunther, Sven" sort="Gunther, Sven" uniqKey="Gunther S" first="Sven" last="Günther">Sven Günther</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson</wicri:regionArea>
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<author><name sortKey="Humbert, Marc" sort="Humbert, Marc" uniqKey="Humbert M" first="Marc" last="Humbert">Marc Humbert</name>
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<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Université Paris-Sud, Le Kremlin-Bicêtre</wicri:regionArea>
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<author><name sortKey="Simonneau, Gerald" sort="Simonneau, Gerald" uniqKey="Simonneau G" first="Gerald" last="Simonneau">Gerald Simonneau</name>
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<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Université Paris-Sud, Le Kremlin-Bicêtre</wicri:regionArea>
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<author><name sortKey="Chemla, Denis" sort="Chemla, Denis" uniqKey="Chemla D" first="Denis" last="Chemla">Denis Chemla</name>
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<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France Université Paris-Sud, Le Kremlin-Bicêtre</wicri:regionArea>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Criteria for diagnosis of exercise pulmonary hypertension.</title>
<author><name sortKey="Herve, Philippe" sort="Herve, Philippe" uniqKey="Herve P" first="Philippe" last="Herve">Philippe Herve</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Chirurgie Thoracique et Vasculaire et de Transplantation Cardio-Pulmonaire, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France herveccml@gmail.com.</nlm:affiliation>
<country wicri:rule="url">Oman</country>
<wicri:regionArea>Département de Chirurgie Thoracique et Vasculaire et de Transplantation Cardio-Pulmonaire, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Lau, Edmund M" sort="Lau, Edmund M" uniqKey="Lau E" first="Edmund M" last="Lau">Edmund M. Lau</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France Sydney Medical School, University of Sydney, Camperdown, Australia.</nlm:affiliation>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France Sydney Medical School, University of Sydney, Camperdown</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Sitbon, Olivier" sort="Sitbon, Olivier" uniqKey="Sitbon O" first="Olivier" last="Sitbon">Olivier Sitbon</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Université Paris-Sud, Le Kremlin-Bicêtre, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Université Paris-Sud, Le Kremlin-Bicêtre</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Savale, Laurent" sort="Savale, Laurent" uniqKey="Savale L" first="Laurent" last="Savale">Laurent Savale</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Montani, David" sort="Montani, David" uniqKey="Montani D" first="David" last="Montani">David Montani</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Université Paris-Sud, Le Kremlin-Bicêtre, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Université Paris-Sud, Le Kremlin-Bicêtre</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Godinas, Laurent" sort="Godinas, Laurent" uniqKey="Godinas L" first="Laurent" last="Godinas">Laurent Godinas</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Lador, Frederic" sort="Lador, Frederic" uniqKey="Lador F" first="Frederic" last="Lador">Frederic Lador</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Jais, Xavier" sort="Jais, Xavier" uniqKey="Jais X" first="Xavier" last="Jaïs">Xavier Jaïs</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Parent, Florence" sort="Parent, Florence" uniqKey="Parent F" first="Florence" last="Parent">Florence Parent</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Gunther, Sven" sort="Gunther, Sven" uniqKey="Gunther S" first="Sven" last="Günther">Sven Günther</name>
<affiliation wicri:level="1"><nlm:affiliation>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson</wicri:regionArea>
</affiliation>
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<author><name sortKey="Humbert, Marc" sort="Humbert, Marc" uniqKey="Humbert M" first="Marc" last="Humbert">Marc Humbert</name>
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<front><div type="abstract" xml:lang="en">The previous definition of exercise pulmonary hypertension (PH) with a mean pulmonary artery pressure (mPAP) >30 mmHg was abandoned because healthy individuals can exceed this threshold at high cardiac output (CO). We hypothesised that incorporating assessment of the pressure-flow relationship using the mPAP/CO ratio, i.e. total pulmonary resistance (TPR), might enhance the accuracy of diagnosing an abnormal exercise haemodynamic response.Exercise haemodynamics were evaluated in 169 consecutive subjects with normal resting mPAP ≤20 mmHg. Subjects were classified into controls without heart or lung disease (n=68) versus patients with pulmonary vascular disease (PVD) (n=49) and left heart disease (LHD) (n=52).TPR and mPAP at maximal exercise produced diagnostic accuracy with area under the receiver operating curve of 0.99 and 0.95, respectively, for discriminating controls versus patients with PVD and LHD. The old criterion of mPAP >30 mmHg had sensitivity of 0.98 but specificity of 0.77. Combining maximal mPAP >30 mmHg and TPR >3 mmHg·min·L(-1) retained sensitivity at 0.93 but improved specificity to 1.0. The accuracy of the combined criteria was high across different age groups, sex, body mass index and diagnosis (PVD or LHD).Combining mPAP >30 mmHg and TPR >3 mmHg·min·L(-1) is superior to mPAP >30 mmHg alone for defining a pathological haemodynamic response of the pulmonary circulation during exercise.</div>
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<DateCompleted><Year>2016</Year>
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<Month>Sep</Month>
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<Title>The European respiratory journal</Title>
<ISOAbbreviation>Eur. Respir. J.</ISOAbbreviation>
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<ArticleTitle>Criteria for diagnosis of exercise pulmonary hypertension.</ArticleTitle>
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<Abstract><AbstractText>The previous definition of exercise pulmonary hypertension (PH) with a mean pulmonary artery pressure (mPAP) >30 mmHg was abandoned because healthy individuals can exceed this threshold at high cardiac output (CO). We hypothesised that incorporating assessment of the pressure-flow relationship using the mPAP/CO ratio, i.e. total pulmonary resistance (TPR), might enhance the accuracy of diagnosing an abnormal exercise haemodynamic response.Exercise haemodynamics were evaluated in 169 consecutive subjects with normal resting mPAP ≤20 mmHg. Subjects were classified into controls without heart or lung disease (n=68) versus patients with pulmonary vascular disease (PVD) (n=49) and left heart disease (LHD) (n=52).TPR and mPAP at maximal exercise produced diagnostic accuracy with area under the receiver operating curve of 0.99 and 0.95, respectively, for discriminating controls versus patients with PVD and LHD. The old criterion of mPAP >30 mmHg had sensitivity of 0.98 but specificity of 0.77. Combining maximal mPAP >30 mmHg and TPR >3 mmHg·min·L(-1) retained sensitivity at 0.93 but improved specificity to 1.0. The accuracy of the combined criteria was high across different age groups, sex, body mass index and diagnosis (PVD or LHD).Combining mPAP >30 mmHg and TPR >3 mmHg·min·L(-1) is superior to mPAP >30 mmHg alone for defining a pathological haemodynamic response of the pulmonary circulation during exercise.</AbstractText>
<CopyrightInformation>Copyright ©ERS 2015.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Herve</LastName>
<ForeName>Philippe</ForeName>
<Initials>P</Initials>
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