{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T17:24:13Z","timestamp":1772040253556,"version":"3.50.1"},"reference-count":42,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2012,8,10]],"date-time":"2012-08-10T00:00:00Z","timestamp":1344556800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Respiratory J"],"published-print":{"date-parts":[[2013,7]]},"abstract":"Abstract<\/jats:title>Objective<\/jats:title>The cause for shortness of breath among systemic sclerosis (SSc<\/jats:styled-content>) patients is often lacking. We sought to characterize the hemodynamics of these patients by using simple isotonic arm exercise during cardiac catheterization.<\/jats:p><\/jats:sec>Methods<\/jats:title>Catheterization was performed in 173 SSc<\/jats:styled-content> patients when resting echocardiographic pulmonary systolic pressures were <40 but >40\u2009mmHg post stress. Patients with resting mean pulmonary arterial pressures (mPAP<\/jats:styled-content>)\u2009\u2264\u200925 and pulmonary arterial wedge pressures (PAWP<\/jats:styled-content>)\u2009\u2264\u200915\u2009mmHg<\/jats:styled-content> exercised with 1\u2010pound hand weights. Normal exercise was defined as a change in mPAP<\/jats:styled-content> divided by the change in cardiac output (CO<\/jats:styled-content>) (\u0394mPAP<\/jats:styled-content>\/\u0394CO<\/jats:styled-content>) ratio\u2009\u2264\u20092 for patients <50 years (\u22643 for >50). An abnormal \u0394mPAP<\/jats:styled-content>\/\u0394CO<\/jats:styled-content> ratio, an exercise transpulmonary gradient (TPG<\/jats:styled-content>)\u2009\u2265\u200915, a PAWP<\/jats:styled-content>\u2009<\u200920, a \u0394TPG<\/jats:styled-content>\u2009>\u2009\u0394PAWP<\/jats:styled-content> and a pulmonary vascular resistance (PVR<\/jats:styled-content>) which increased defined exercise\u2010induced pulmonary arterial hypertension (EIPAH<\/jats:styled-content>). An abnormal \u0394mPAP<\/jats:styled-content>\/\u0394CO<\/jats:styled-content> ratio, an exercise TPG<\/jats:styled-content>\u2009<\u200915, a PAWP<\/jats:styled-content>\u2009\u2265\u200920, a \u0394TPG<\/jats:styled-content>\u2009<\u2009\u0394PAWP<\/jats:styled-content> and a drop in PVR<\/jats:styled-content> defined left ventricular diastolic dysfunction (DD<\/jats:styled-content>). Twelve patients without SSc<\/jats:styled-content> served as controls.<\/jats:p><\/jats:sec>Results<\/jats:title>Pulmonary pressures increased with exercise in 53 patients. Six had EIPAH<\/jats:styled-content> and 47 had DD<\/jats:styled-content>. With exercise, mPAP<\/jats:styled-content> and PAWP<\/jats:styled-content> were 20\u2009\u00b1\u20094 and 13\u2009\u00b1\u20092 in controls, 36\u2009\u00b1\u20093 and 12\u2009\u00b1\u20094 in EIPAH<\/jats:styled-content> and 34\u2009\u00b1\u20096 and 26\u2009\u00b1\u20094 in DD<\/jats:styled-content>. Control \u0394mPAP<\/jats:styled-content>\/\u0394CO<\/jats:styled-content> was 0.8\u2009\u00b1\u20090.7, 7.5\u2009\u00b1\u20093.9 in EIPAH<\/jats:styled-content> and 9.1\u2009\u00b1\u20097.2 in DD<\/jats:styled-content>. Rest and exercise TPG<\/jats:styled-content> was normal for control and DD<\/jats:styled-content> patients but increased (12\u2009\u00b1\u20094 to 23\u2009\u00b1\u20094) in EIPAH<\/jats:styled-content> (P<\/jats:styled-content><\/jats:italic>\u2009<\u20090.0001). PVR<\/jats:styled-content> decreased in DD<\/jats:styled-content> but increased in EIPAH<\/jats:styled-content> with exercise.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Exercise during catheterization elucidates the pathophysiology of dyspnea and distinguishes EIPAH<\/jats:styled-content> from the more common DD<\/jats:styled-content> in SSc<\/jats:styled-content> patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/j.1752-699x.2012.00310.x","type":"journal-article","created":{"date-parts":[[2012,7,13]],"date-time":"2012-07-13T08:22:51Z","timestamp":1342167771000},"page":"227-236","source":"Crossref","is-referenced-by-count":27,"title":["Exercise during cardiac catheterization distinguishes between pulmonary and left ventricular causes of dyspnea in systemic sclerosis patients"],"prefix":"10.1111","volume":"7","author":[{"given":"W. 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