{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:43:16Z","timestamp":1790804596546,"version":"4.1.0"},"reference-count":26,"publisher":"BMJ","issue":"10","funder":[{"DOI":"10.13039\/100005646","name":"Actelion Pharmaceuticals","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100005646","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2016,10,28]]},"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Pulmonary arterial hypertension (PAH) is a devastating disease with limited survival and occurs as a frequent complication in patients with systemic sclerosis (SSc). A definite diagnosis of PAH is obtained by right heart catheterisation (RHC); however, the initial suspicion is raised by non-invasive methods. We assessed the diagnostic accuracy of key parameters derived from cardiopulmonary exercise testing (CPET) for detecting and ruling out SSc-associated PAH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a multicentre setting, we prospectively evaluated 173 consecutive patients with SSc without known PAH, but with clinical suspicion of PAH. Each patient underwent CPET and RHC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      RHC identified PAH in 48 patients (27.8%), postcapillary pulmonary hypertension (PH) in 10 patients (5.8%) and ruled out PH in 115 patients (66.5%). CPET parameters correlated significantly with pulmonary haemodynamics. PeakVO\n                      <jats:sub>2<\/jats:sub>\n                      and VE\/VCO\n                      <jats:sub>2<\/jats:sub>\n                      showed highest correlations with pulmonary arterial pressure, transpulmonary pressure gradient and pulmonary vascular resistance. Several parameters showed high sensitivity and specificity for PAH detection by receiver operating characteristic analysis. However, peakVO\n                      <jats:sub>2<\/jats:sub>\n                      showed highest diagnostic accuracy (sensitivity 87.5%, specificity 74.8% at a threshold level of 13.8\u2005mL\/min\/kg). A peakVO\n                      <jats:sub>2<\/jats:sub>\n                      of &gt;18.7\u2005mL\/kg\/min was reached by 38\/173 patients (22%) and excluded PAH in our cohort (negative predictive value 1.0). A nadir VE\/VCO\n                      <jats:sub>2<\/jats:sub>\n                      ratio of &gt;45.5 showed a positive predictive value of 1.0. Diagnostic accuracy was highest in patients with low pulmonary arterial wedge pressure (&lt;12\u2005mm\u2005Hg). There were no study-related serious adverse events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CPET is a safe and valuable method in the non-invasive detection of SSc-associated PAH. It may be particularly beneficial for reducing unnecessary RHC procedures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/heartjnl-2016-309981","type":"journal-article","created":{"date-parts":[[2017,1,6]],"date-time":"2017-01-06T20:47:25Z","timestamp":1483735645000},"page":"774-782","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":81,"title":["Cardiopulmonary exercise testing for detecting pulmonary arterial hypertension in systemic sclerosis"],"prefix":"10.1136","volume":"103","author":[{"given":"Daniel","family":"Dumitrescu","sequence":"first","affiliation":[{"name":"Herzzentrum der Universit\u00e4t zu K\u00f6ln, Klinik III f\u00fcr Innere Medizin, Cologne, Germany"},{"name":"Cologne Cardiovascular Research Center (CCRC), University of Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Nagel","sequence":"additional","affiliation":[{"name":"Center for Pulmonary Hypertension, Thoraxklinik Heidelberg, Heidelberg, Germany"},{"name":"Lung Center, Klinikum Mittelbaden, Baden-Baden Balg, Baden-Baden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabor","family":"Kovacs","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine, Ludwig Boltzmann Institute for Lung Vascular Research, and Medical University of Graz, Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Bollmann","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine B\u2014Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University of Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Halank","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Carl Gustav Carus University Hospital, Technical University of Dresden, Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Winkler","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Innere Medizin I, University of Leipzig, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Hellmich","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum K\u00f6ln, Institut f\u00fcr Medizinische Statistik, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekkehard","family":"Gr\u00fcnig","sequence":"additional","affiliation":[{"name":"Center for Pulmonary Hypertension, Thoraxklinik Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horst","family":"Olschewski","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine, Ludwig Boltzmann Institute for Lung Vascular Research, and Medical University of Graz, Graz, 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increase of exercise-induced pulmonary artery pressure in systemic sclerosis patients predominantly results from left ventricular diastolic dysfunction","volume":"102","author":"Ciurzy\u0144ski","year":"2013","journal-title":"Clin Res Cardiol"},{"key":"2025100705321519000_103.10.774.18","doi-asserted-by":"publisher","DOI":"10.1161\/hc2901.093198"},{"key":"2025100705321519000_103.10.774.19","doi-asserted-by":"publisher","DOI":"10.1378\/chest.127.5.1637"},{"key":"2025100705321519000_103.10.774.20","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00035005"},{"key":"2025100705321519000_103.10.774.21","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1016\/S0167-5273(11)70489-2","article-title":"Pulmonary hypertension: hemodynamic evaluation. 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