{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:48:34Z","timestamp":1785890914108,"version":"3.56.0"},"reference-count":24,"publisher":"Elsevier BV","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000222","name":"Heart and Stroke Foundation of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000222","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004411","name":"Heart and Stroke Foundation of Canada","doi-asserted-by":"publisher","award":["G-18-0022220"],"award-info":[{"award-number":["G-18-0022220"]}],"id":[{"id":"10.13039\/100004411","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cjcopen.ca","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["CJC Open"],"published-print":{"date-parts":[[2026,6]]},"DOI":"10.1016\/j.cjco.2026.02.005","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T20:36:04Z","timestamp":1771360564000},"page":"757-765","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Upfront Exercise Hemodynamic Phenotyping of Patients with Pulmonary Hypertension and Left Heart Disease Risk Factors: A Prospective Experience"],"prefix":"10.1016","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0361-0469","authenticated-orcid":false,"given":"Elizabeth","family":"Karvasarski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Savaris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Beale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Bentley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Granton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2193-602X","authenticated-orcid":false,"given":"Susanna","family":"Mak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.cjco.2026.02.005_bib1","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1378\/chest.09-1140","article-title":"Pulmonary arterial hypertension: baseline characteristics from the REVEAL registry","volume":"137","author":"Badesch","year":"2010","journal-title":"Chest"},{"key":"10.1016\/j.cjco.2026.02.005_bib2","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1056\/NEJMoa1413687","article-title":"Initial use of ambrisentan plus tadalafil in pulmonary arterial hypertension","volume":"373","author":"Gali\u00e8","year":"2015","journal-title":"N Engl J Med"},{"key":"10.1016\/j.cjco.2026.02.005_bib3","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00879-2022","article-title":"2022 ESC\/ERS guidelines for the diagnosis and treatment of pulmonary hypertension","volume":"61","author":"Humbert","year":"2023","journal-title":"Eur Respir J"},{"key":"10.1016\/j.cjco.2026.02.005_bib4","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1164\/rccm.202402-0359VP","article-title":"\u201cThis patient needs a doctor, not a guideline!\u201d The zone of uncertainty in pulmonary arterial wedge pressure measurement","volume":"210","author":"Rayner","year":"2024","journal-title":"Am J Respir Crit Care Med"},{"key":"10.1016\/j.cjco.2026.02.005_bib5","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1161\/CIRCULATIONAHA.118.034646","article-title":"A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction","volume":"138","author":"Reddy","year":"2018","journal-title":"Circulation"},{"key":"10.1016\/j.cjco.2026.02.005_bib6","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1152\/japplphysiol.00148.2025","article-title":"Pre- and post-capillary exercise contributions to pulmonary hypertension in adults > 45 years","volume":"139","author":"Karvasarski","year":"2025","journal-title":"J Appl Physiol (1985)"},{"key":"10.1016\/j.cjco.2026.02.005_bib7","doi-asserted-by":"crossref","unstructured":"Mounsey LA, Kalaria CJ, Kowal A, et al. Exercise hemodynamics and the evolving definition of precapillary pulmonary hypertension. Chest https:\/\/doi.org\/10.1016\/j.chest.2025.03.035.","DOI":"10.1016\/j.chest.2025.03.035"},{"key":"10.1016\/j.cjco.2026.02.005_bib8","doi-asserted-by":"crossref","DOI":"10.14814\/phy2.15559","article-title":"Alterations of pulmonary vascular afterload in exercise-induced pre- and post-capillary pulmonary hypertension","volume":"11","author":"Karvasarski","year":"2023","journal-title":"Physiol Rep"},{"key":"10.1016\/j.cjco.2026.02.005_bib9","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.03181-2021","article-title":"Diagnostic, prognostic and differential-diagnostic relevance of pulmonary haemodynamic parameters during exercise: a systematic review","volume":"60","author":"Zeder","year":"2022","journal-title":"Eur Respir J"},{"key":"10.1016\/j.cjco.2026.02.005_bib10","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1002\/(SICI)1097-0258(19990615)18:11<1341::AID-SIM129>3.0.CO;2-7","article-title":"Combining mortality and longitudinal measures in clinical trials","volume":"18","author":"Finkelstein","year":"1999","journal-title":"Stat Med"},{"key":"10.1016\/j.cjco.2026.02.005_bib11","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s13741-025-00550-8","article-title":"Efficient statistical analysis of trial designs: win ratio and related approaches for composite outcomes","volume":"14","author":"Fandino","year":"2025","journal-title":"Perioper Med (Lond)"},{"key":"10.1016\/j.cjco.2026.02.005_bib12","article-title":"Interpretational challenges of the win ratio in analyzing hierarchical composite endpoints in chronic kidney disease","author":"Thomsen","year":"2025","journal-title":"arXiv"},{"key":"10.1016\/j.cjco.2026.02.005_bib13","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1161\/CIRCHEARTFAILURE.109.930701","article-title":"Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction","volume":"3","author":"Borlaug","year":"2010","journal-title":"Circ Heart Fail"},{"key":"10.1016\/j.cjco.2026.02.005_bib14","first-page":"E233","article-title":"SCAI\/HFSA clinical expert consensus document on the use of invasive hemodynamics for the diagnosis and management of cardiovascular disease","volume":"89","author":"Sorajja","year":"2017","journal-title":"Catheter Cardiovasc Interv"},{"key":"10.1016\/j.cjco.2026.02.005_bib15","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.015992","article-title":"Noninvasive prediction of elevated wedge pressure in pulmonary hypertension patients without clear signs of left-sided heart disease: external validation of the OPTICS risk score","volume":"9","author":"Jansen","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"10.1016\/j.cjco.2026.02.005_bib16","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.healun.2022.05.007","article-title":"Idiopathic pulmonary arterial hypertension patients with a high H2FPEF-score: insights from the Amsterdam UMC PAH-cohort","volume":"41","author":"Kianzad","year":"2022","journal-title":"J Heart Lung Transplant"},{"key":"10.1016\/j.cjco.2026.02.005_bib17","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1016\/j.cardfail.2025.09.006","article-title":"Diagnostic performance of passive leg-raise and low-workload exercise to diagnose heart failure with preserved ejection fraction","volume":"31","author":"Baratto","year":"2025","journal-title":"J Card Fail"},{"key":"10.1016\/j.cjco.2026.02.005_bib18","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1002\/ejhf.2747","article-title":"Central haemodynamic abnormalities and outcome in patients with unexplained dyspnoea","volume":"25","author":"Omote","year":"2023","journal-title":"Eur J Heart Fail"},{"key":"10.1016\/j.cjco.2026.02.005_bib19","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1093\/eurjhf\/hft044","article-title":"Impact of right ventricular reserve on exercise capacity and survival in patients with pulmonary hypertension","volume":"15","author":"Blumberg","year":"2013","journal-title":"Eur J Heart Fail"},{"key":"10.1016\/j.cjco.2026.02.005_bib20","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jacc.2019.10.048","article-title":"Exercise pulmonary hypertension predicts clinical outcomes in patients with dyspnea on effort","volume":"75","author":"Ho","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.cjco.2026.02.005_bib21","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/j.ijcard.2012.10.026","article-title":"Elderly patients diagnosed with idiopathic pulmonary arterial hypertension: results from the COMPERA registry","volume":"168","author":"Hoeper","year":"2013","journal-title":"Int J Cardiol"},{"key":"10.1016\/j.cjco.2026.02.005_bib22","doi-asserted-by":"crossref","DOI":"10.1002\/pul2.12103","article-title":"The role of exercise right heart catheterization to guide pulmonary hypertension therapy in older adults","volume":"12","author":"Mak","year":"2022","journal-title":"Pulm Circ"},{"key":"10.1016\/j.cjco.2026.02.005_bib23","article-title":"Prognostic relevance of exercise pulmonary hypertension: results of the multicentre PEX-NET Clinical Research Collaboration","volume":"64","author":"Kovacs","year":"2024","journal-title":"Eur Respir J"},{"key":"10.1016\/j.cjco.2026.02.005_bib24","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1002\/ejhf.2853","article-title":"The win ratio method in heart failure trials: lessons learnt from EMPULSE","volume":"25","author":"Pocock","year":"2023","journal-title":"Eur J Heart Fail"}],"container-title":["CJC Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2589790X26000211?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2589790X26000211?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T23:53:25Z","timestamp":1785887605000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2589790X26000211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["S2589790X26000211"],"URL":"https:\/\/doi.org\/10.1016\/j.cjco.2026.02.005","relation":{},"ISSN":["2589-790X"],"issn-type":[{"value":"2589-790X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Upfront Exercise Hemodynamic Phenotyping of Patients with Pulmonary Hypertension and Left Heart Disease Risk Factors: A Prospective Experience","name":"articletitle","label":"Article Title"},{"value":"CJC Open","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.cjco.2026.02.005","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.","name":"copyright","label":"Copyright"}]}}