{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:59:10Z","timestamp":1781614750277,"version":"3.54.5"},"reference-count":11,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,5,30]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Pulmonary hypertension associated with chronic obstructive pulmonary disease (PH-COPD) is associated with poor outcomes, yet resting haemodynamics incompletely capture disease severity. We evaluated whether integrating submaximal cardiopulmonary exercise testing variables with transthoracic echocardiographic and pulmonary function test parameters improves prognostic assessment in PH-COPD beyond resting haemodynamics alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Single-tertiary pulmonary vascular disease referral centre in the USA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>67 patients with PH-COPD who underwent right heart catheterisation and complementary non-invasive testing between 2019 and 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was a composite of heart failure hospitalisation or all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Associations between physiologic variables and outcomes were assessed using Cox proportional hazards models and survival tree analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The composite outcome occurred in 47.1% of patients over a median follow-up of 518 (229\u2013897) days. Several non-invasive dynamic physiologic variables were associated with adverse outcomes, including lower gas exchange-derived pulmonary vascular capacitance (Gx\n                      <jats:sub>CAP<\/jats:sub>\n                      ) (HR 0.997, 95%\u2009CI 0.995 to 0.999; p=0.013), lower oxygen uptake efficiency slope (HR 0.983, 95%\u2009CI 0.968 to 0.998; p=0.030), lower submaximal VO\n                      <jats:sub>2<\/jats:sub>\n                      (HR 0.978, 95%\u2009CI 0.959 to 0.997; p=0.022) and lower ETCO\n                      <jats:sub>2<\/jats:sub>\n                      (HR 0.886, 95%\u2009CI 0.820 to 0.957; p=0.002). Higher estimated right ventricular systolic pressure (eRVSP) on echocardiogram (HR 1.015, 95%\u2009CI 1.001 to 1.029; p=0.032) and pulmonary vascular resistance (PVR) on right heart catheterisation (HR 1.087, 95%\u2009CI 1.005 to 1.176; p=0.038) were also associated with adverse outcomes, although no optimal prognostic PVR threshold was identified. In the survival tree model, Gx\n                      <jats:sub>CAP<\/jats:sub>\n                      &lt;243\u2009mL\/mm Hg provided the initial and most influential split. Patients with both Gx\n                      <jats:sub>CAP<\/jats:sub>\n                      &lt;243\u2009mL\/mm Hg and eRVSP&gt;45\u2009mm Hg represented the highest-risk subgroup (relative HR 4.4). Including PVR did not improve prognostic performance of the analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Dynamic exercise-derived physiologic markers provide prognostic information complementary to resting haemodynamic assessment in PH-COPD and may improve risk stratification across this heterogeneous population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2026-004192","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:27:31Z","timestamp":1781612851000},"page":"e004192","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond PVR: dynamic physiologic assessment enhances prognostic evaluation in pulmonary hypertension associated with chronic obstructive pulmonary disease"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0875-8663","authenticated-orcid":false,"given":"Elizabeth S","family":"Tarras","sequence":"first","affiliation":[{"name":"Department of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiting","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1224-4665","authenticated-orcid":false,"given":"Christopher","family":"Gange","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Kurz","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inderjit","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"2026061605253589000_13.1.e004192.1","article-title":"Severe pulmonary hypertension in chronic obstructive pulmonary disease - From clinical perspective to histological evidence","volume":"17","author":"Zeder","year":"2024","journal-title":"Int J Cardiol Congenit Heart Dis"},{"key":"2026061605253589000_13.1.e004192.2","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1164\/rccm.201801-0095PP","article-title":"Pulmonary Vascular Involvement in Chronic Obstructive Pulmonary Disease. Is There a Pulmonary Vascular Phenotype?","volume":"198","author":"Kovacs","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"2026061605253589000_13.1.e004192.3","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00879-2022"},{"key":"2026061605253589000_13.1.e004192.4","doi-asserted-by":"crossref","DOI":"10.1002\/pul2.12197","article-title":"Noninvasive determinants of pulmonary hypertension in interstitial lung disease","volume":"13","author":"Joseph","year":"2023","journal-title":"Pulm Circ"},{"key":"2026061605253589000_13.1.e004192.5","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1016\/S2213-2600(24)00413-2","article-title":"GOLD COPD report: 2025 update","volume":"13","author":"Venkatesan","year":"2025","journal-title":"Lancet Respir Med"},{"key":"2026061605253589000_13.1.e004192.6","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1164\/rccm.202311-2037ED","article-title":"Pulmonary Artery Wedge Pressure in the Diagnosis of Pulmonary Arterial Hypertension","volume":"209","author":"Naeije","year":"2024","journal-title":"Am J Respir Crit Care Med"},{"key":"2026061605253589000_13.1.e004192.7","doi-asserted-by":"crossref","DOI":"10.1177\/2045894020972273","article-title":"Diagnostic utility of sub-maximum cardiopulmonary exercise testing in the ambulatory setting for heart failure with preserved ejection fraction","volume":"10","author":"Oakland","year":"2020","journal-title":"Pulm Circ"},{"key":"2026061605253589000_13.1.e004192.8","doi-asserted-by":"crossref","first-page":"53","DOI":"10.4137\/CCRPM.S12178","article-title":"Use of noninvasive gas exchange to track pulmonary vascular responses to exercise in heart failure","volume":"7","author":"Taylor","year":"2013","journal-title":"Clin Med Insights Circ Respir Pulm Med"},{"key":"2026061605253589000_13.1.e004192.9","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201509-599FR"},{"key":"2026061605253589000_13.1.e004192.10","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00694.2009"},{"key":"2026061605253589000_13.1.e004192.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2022.01.031"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2026-004192","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:27:32Z","timestamp":1781612852000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2026-004192"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,6,16]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bmjresp-2026-004192"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2026-004192","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}