{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:59:05Z","timestamp":1790841545714,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pulm. circ."],"published-print":{"date-parts":[[2026,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Level 3 cardiopulmonary exercise testing (CPET) can unmask the dynamic burden of pulmonary vascular disease (PVD), while submaximal exercise testing offers a simpler, noninvasive alternative. Emerging markers such as a gas\u2010exchange derived estimate of pulmonary vascular capacitance (GXCAP) and ventilatory efficiency (VE\/VCO\n 2<\/jats:sub>\n ) may reflect PVD and correlate with invasive hemodynamics. Level 3 CPET has been used to stratify PH\u2010ILD patients into those with exercise\u2010induced increases in pulmonary vascular resistance (PVR\n D<\/jats:sub>\n ) and those with static PVR (PVR\n S<\/jats:sub>\n ). This study evaluated whether GXCAP and VE\/VCO\n 2<\/jats:sub>\n measured during submaximal testing could identify non\u2010severe PH\u2010ILD patients with exercise\u2010induced increases in PVR. GXCAP and VE\/VCO\n 2<\/jats:sub>\n were retrospectively analyzed in 16 non\u2010severe PH\u2010ILD patients who underwent both submaximal exercise testing and invasive Level 3 CPET. Patients were previously categorized as having dynamic (PVR\n D<\/jats:sub>\n ) or stable (PVR\n S<\/jats:sub>\n ) PVR responses. Between\u2010group differences were assessed using unpaired t\u2010tests, and receiver operating characteristic (ROC) analysis evaluated the ability of each variable to identify the PVR\n D<\/jats:sub>\n phenotype. Among the 16 patients included in the analysis, 6 were classified as PVR\n S<\/jats:sub>\n and 10 as PVR\n D<\/jats:sub>\n . Baseline characteristics, including peak VO\n 2<\/jats:sub>\n , were similar between groups. Mean GXCAP was significantly higher in PVR\n S<\/jats:sub>\n (471\u2009\u00b1\u200985\u2009mL\u00b7mmHg) than in PVR\n D<\/jats:sub>\n (311\u2009\u00b1\u200938\u2009mL\u00b7mmHg,\n p<\/jats:italic>\n \u2009<\u20090.01), while VE\/VCO\n 2<\/jats:sub>\n was lower in PVR\n S<\/jats:sub>\n (33\u2009\u00b1\u20092 vs 37\u2009\u00b1\u20092.5,\n p<\/jats:italic>\n \u2009<\u20090.01). ROC analysis demonstrated excellent discriminatory performance for GXCAP (AUC 0.98) and good discrimination for VE\/VCO\n 2<\/jats:sub>\n (AUC 0.90). The GXCAP\/VE\/VCO\n 2<\/jats:sub>\n ratio performed similarly (AUC 0.98). These findings suggest that GXCAP and VE\/VCO\n 2<\/jats:sub>\n obtained during submaximal testing may serve as practical, noninvasive tools for identifying exercise\u2010induced pulmonary vascular impairment and aiding risk stratification in patients with non\u2010severe PH\u2010ILD. However, validation in larger prospective cohorts is needed.\n <\/jats:p>","DOI":"10.1002\/pul2.70358","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T11:05:53Z","timestamp":1785150353000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Noninvasive Gas Exchange Determinants of Exercise Hemodynamics in Non\u2010Severe Pulmonary Hypertension Associated With Interstitial Lung Disease"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2377-7859","authenticated-orcid":false,"given":"Chebly","family":"Dagher","sequence":"first","affiliation":[{"name":"Department of Internal Medicine University of Connecticut Farmington Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4913-7684","authenticated-orcid":false,"given":"Niala","family":"Moallem","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine University of Southern California Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett","family":"Fiscus","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine Hartford Hospital Hartford Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Carollo","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine Hartford Hospital Hartford Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Swanson","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine Hartford Hospital Hartford Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harrison W.","family":"Farber","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine Tufts Medical Center Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3063-6002","authenticated-orcid":false,"given":"Raj","family":"Parikh","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine Hartford Hospital Hartford Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac237"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1183\/20734735.0205-2022"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2008470"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02414-2022"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.08.012"},{"issue":"23","key":"e_1_2_13_7_1","first-page":"2927","article-title":"EACPR\/AHA Joint Scientific Statement. Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations","volume":"33","author":"Guazzi M.","year":"2012","journal-title":"European Heart Journal"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0134-2017"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/life15071089"},{"key":"e_1_2_13_10_1","first-page":"A5541","volume-title":"C63 Thinking Outside the Box: New Insights Into Subgroups of Pulmonary Hypertension","author":"Moallem N.","year":"2023"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pul2.12197"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2017.07.397"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.4137\/CCRPM.S12178"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3181e52e69"},{"key":"e_1_2_13_15_1","unstructured":"K. E.Sietsema W. W.Stringer D. Y.Sue et al. Wasserman and Whipp's: Principles of Exercise Testing and Interpretation: Including Pathophysiology and Clinical Applications(Lippincott Williams & Wilkins 2020)."},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00260-2018"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00041.2010"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/962598"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0214-2020"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2017.03.022"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2005.03.007"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/resp.12206"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/2045894020972273"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2016.12.011"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2023-002116"}],"container-title":["Pulmonary Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pul2.70358","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pul2.70358","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pul2.70358","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:20:12Z","timestamp":1790839212000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pul2.70358"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":24,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/pul2.70358"],"URL":"https:\/\/doi.org\/10.1002\/pul2.70358","archive":["Portico"],"relation":{},"ISSN":["2045-8940","2045-8940"],"issn-type":[{"value":"2045-8940","type":"print"},{"value":"2045-8940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-03-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70358"}}