{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T14:06:29Z","timestamp":1783001189396,"version":"3.54.5"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,7,1]],"date-time":"2019-07-01T00:00:00Z","timestamp":1561939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and objective<\/jats:title><jats:p>Clinical presentations associated with chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH) at rest are highly similar. Differentiating between CTEPH and PAH using non\u2010invasive techniques remains challenging. Thus, we examined whether analysis of ventilatory gas in response to postural changes can be useful as a non\u2010invasive screening method for pulmonary hypertension (PH), and help differentiate CTEPH from PAH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively enrolled 90 patients with suspected PH and performed right heart catheterization, ventilation\/perfusion scan and ventilatory gas analysis. Various pulmonary function parameters were examined in the supine and sitting postures, and postural changes were calculated (\u0394(supine \u2212 sitting)).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 25 patients with newly diagnosed PAH, 40 patients with newly diagnosed CTEPH and 25 non\u2010PH patients were included. \u0394End\u2010tidal CO<jats:sub>2<\/jats:sub> pressure (P<jats:sub>ET<\/jats:sub>CO<jats:sub>2<\/jats:sub>) was significantly lower in patients with CTEPH and PAH than in non\u2010PH patients (both <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). \u0394P<jats:sub>ET<\/jats:sub>CO<jats:sub>2<\/jats:sub>\u2009&lt;\u20090\u2009mm Hg could effectively differentiate PH from non\u2010PH (area under the curve (AUC) = 0.969, sensitivity = 89%, specificity = 100%). Postural change from sitting to supine significantly increased the ratio of ventilation to CO<jats:sub>2<\/jats:sub> production (VE\/VCO<jats:sub>2<\/jats:sub>) in the CTEPH group (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). By contrast, VE\/VCO<jats:sub>2<\/jats:sub> significantly decreased in the PAH group (<jats:italic>P<\/jats:italic> = 0.001). Notably, CTEPH presented with higher \u0394VE\/VCO<jats:sub>2<\/jats:sub> than PAH, although no differences were observed in haemodynamic and echocardiographic parameters between the two groups (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Furthermore, \u0394VE\/VCO<jats:sub>2<\/jats:sub>\u2009&gt;\u20090.8 could effectively differentiate CTEPH from PAH (AUC = 0.849, sensitivity = 78%, specificity = 88%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Postural changes in ventilatory gas analysis are useful as a non\u2010invasive bedside evaluation to screen for the presence of PH and distinguish between CTEPH and PAH.<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.13618","type":"journal-article","created":{"date-parts":[[2019,7,1]],"date-time":"2019-07-01T23:57:07Z","timestamp":1562025427000},"page":"427-434","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Non\u2010invasive screening using ventilatory gas analysis to distinguish between chronic thromboembolic pulmonary hypertension and pulmonary arterial hypertension"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1227-7579","authenticated-orcid":false,"given":"Mina","family":"Akizuki","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Rehabilitation Science Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichiro","family":"Sugimura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuo","family":"Aoki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaaki","family":"Kakihana","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Rehabilitation Science Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Tatebe","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saori","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruka","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimio","family":"Satoh","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Shimokawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Kohzuki","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Rehabilitation Science Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.602565"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00009211"},{"key":"e_1_2_8_4_1","unstructured":"GalieN HumbertM VachieryJL GibbsS LangI TorbickiA SimonneauG PeacockA Vonk NoordegraafA BeghettiMet al.;ESC Scientific Document Group. 2015 ESC\/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC) International Society for Heart and Lung Transplantation (ISHLT).Eur. 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