{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:48:39Z","timestamp":1793148519051,"version":"4.5.0"},"reference-count":44,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,4,10]],"date-time":"2019-04-10T00:00:00Z","timestamp":1554854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis & Rheumatology"],"published-print":{"date-parts":[[2019,5]]},"abstract":"Objective<\/jats:title>This prospective study was undertaken to evaluate right ventricular function and pulmonary arterial compliance (PAC<\/jats:styled-content>; ratio of stroke volume to pulse pressure) at rest and during exercise in patients with systemic sclerosis (SS<\/jats:styled-content>c) with normal mean pulmonary artery pressure (PAP<\/jats:styled-content>), patients with SS<\/jats:styled-content>c with mildly elevated mean PAP<\/jats:styled-content>, and patients with SS<\/jats:styled-content>c with manifest pulmonary hypertension (PH<\/jats:styled-content>).<\/jats:p><\/jats:sec>Methods<\/jats:title>Patients with SS<\/jats:styled-content>c (n = 112) underwent clinical assessment and right\u2010sided heart catheterization at rest and during exercise and were divided into 3 groups according to their resting mean PAP<\/jats:styled-content> values: normal mean PAP<\/jats:styled-content> (\u226420 mm Hg), mildly elevated mean PAP<\/jats:styled-content> (21\u201324 mm Hg), and PH<\/jats:styled-content> (mean PAP<\/jats:styled-content> \u226525 mm Hg). Results were compared between groups by analysis of variance followed by post hoc Student's t<\/jats:italic>\u2010test.<\/jats:p><\/jats:sec>Results<\/jats:title>Compared to patients with normal mean PAP<\/jats:styled-content>, patients with mildly elevated mean PAP<\/jats:styled-content> had a lower 6\u2010minute walking distance (P<\/jats:italic> = 0.008), lower cardiac index (P<\/jats:italic> = 0.027) and higher pulmonary vascular resistance (P<\/jats:italic> = 0.0002) during exercise, and lower PAC<\/jats:styled-content> at rest (P<\/jats:italic> = 0.016) and different stages of exercise (P<\/jats:italic> = 0.033 for 25W and P<\/jats:italic> = 0.024 for 75W).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>The results of this study suggest that impaired 6\u2010minute walking distance in SS<\/jats:styled-content>c patients with mildly elevated mean PAP<\/jats:styled-content> might be caused by reduced PAC<\/jats:styled-content> during exercise and reduced right ventricular output reserve, presumably due to impaired coupling between the right ventricle and the pulmonary vasculature. These findings provide further evidence of the clinical relevance of mildly elevated mean PAP<\/jats:styled-content> in patients with SS<\/jats:styled-content>c.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.40814","type":"journal-article","created":{"date-parts":[[2019,1,8]],"date-time":"2019-01-08T16:46:05Z","timestamp":1546965965000},"page":"805-816","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Reduced Right Ventricular Output Reserve in Patients With Systemic Sclerosis and Mildly Elevated Pulmonary Artery Pressure"],"prefix":"10.1002","volume":"71","author":[{"given":"Christian","family":"Nagel","sequence":"first","affiliation":[{"name":"Heidelberg University Hospital, German Center for Lung Research, Heidelberg, Germany, and Klinikum Mittelbaden Baden\u2010Baden Balg Baden\u2010Baden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto M.","family":"Marra","sequence":"additional","affiliation":[{"name":"SDN Scientific Institute for Research and Healthcare Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Heidelberg University Hospital, German Center for Lung Research Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Blank","sequence":"additional","affiliation":[{"name":"University Hospital Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Cittadini","sequence":"additional","affiliation":[{"name":"University Federico II of Naples Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerry","family":"Coghlan","sequence":"additional","affiliation":[{"name":"Royal Free Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Distler","sequence":"additional","affiliation":[{"name":"University Hospital Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Denton","sequence":"additional","affiliation":[{"name":"Royal Free Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Egenlauf","sequence":"additional","affiliation":[{"name":"Heidelberg University Hospital, German Center for Lung Research Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Fiehn","sequence":"additional","affiliation":[{"name":"Baden\u2010Baden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Fischer","sequence":"additional","affiliation":[{"name":"University Hospital Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satenik","family":"Harutyunova","sequence":"additional","affiliation":[{"name":"Heidelberg University Hospital, German Center for Lung Research Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius M.","family":"Hoeper","sequence":"additional","affiliation":[{"name":"Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanns\u2010Martin","family":"Lorenz","sequence":"additional","affiliation":[{"name":"University Hospital Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiota","family":"Xanthouli","sequence":"additional","affiliation":[{"name":"Heidelberg University Hospital, German Center for Lung Research Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Bossone","sequence":"additional","affiliation":[{"name":"A. Cardarelli Hospital Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekkehard","family":"Gr\u00fcnig","sequence":"additional","affiliation":[{"name":"Heidelberg University Hospital, German Center for Lung Research Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4,10]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200806-953OC"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.38040"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar4051"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.38029"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.10.032"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv317"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-014-0493-1"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-0194"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00145608"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.37838"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hft044"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00153613"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201509-599FR"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2017.10.019"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.000667"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.001573"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780230510"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.166.1.at1102"},{"key":"e_1_2_7_20_1","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1164\/rccm.201402-0269PP","article-title":"Reading pulmonary vascular pressure tracings: how to handle the problems of zero leveling and respiratory swings","volume":"190","author":"Kovacs G","year":"2014","journal-title":"Am J Respir Crit Care Med"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00578-2017"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.70.4.657"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.15.1788"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-203301"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.01023.2002"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-015-0618-x"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.022082"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.11.186"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0081684"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.022415"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2008.08.007"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.10.027"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccl.2012.03.004"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2014.01.004"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00741-2015"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2006.03.008"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/2045893217698715"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.12.099"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.033147"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.112.000008"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00021915"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01684-2015"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1086\/674756"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1177\/2045893217709025"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.33460"}],"container-title":["Arthritis & Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fart.40814","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/art.40814","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/art.40814","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/art.40814","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T12:27:31Z","timestamp":1759926451000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/art.40814"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,10]]},"references-count":44,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.1002\/art.40814"],"URL":"https:\/\/doi.org\/10.1002\/art.40814","archive":["Portico"],"relation":{},"ISSN":["2326-5191","2326-5205"],"issn-type":[{"value":"2326-5191","type":"print"},{"value":"2326-5205","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,10]]},"assertion":[{"value":"2018-06-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-04-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}