{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:21:35Z","timestamp":1790767295219,"version":"4.1.0"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,11,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Resting right heart catheterization can assess both left heart filling and pulmonary artery (PA) pressures to identify and classify pulmonary hypertension. Although exercise may further elucidate hemodynamic abnormalities, current pulmonary hypertension classifications do not consider the expected interrelationship between PA and left heart filling pressures. This study explored the utility of this relationship to enhance the classification of exercise hemodynamic phenotypes in pulmonary hypertension.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Data from 36 healthy individuals (55, 50\u201360\u00a0years, 50% male) and 85 consecutive patients (60, 49\u201371\u00a0years, 48% male) with dyspnea and\/or suspected pulmonary hypertension of uncertain etiology were analyzed. Right heart catheterization was performed at rest and during semiupright submaximal cycling. To classify exercise phenotypes in patients, upper 95% CIs were identified from the healthy individuals for the change from rest to exercise in mean PA pressure over cardiac output (\u0394mPAP\/\u0394CO \u22643.2\u00a0Wood units [WU]), pulmonary artery wedge pressure over CO (\u0394PAWP\/\u0394CO \u22642\u00a0mm\u00a0Hg\/L per minute), and exercise PA pulse pressure over PAWP (PP\/PAWP \u22642.5). Among patients with a \u0394mPAP\/\u0394CO \u22643.2\u00a0WU, the majority (84%) demonstrated a \u0394PAWP\/\u0394CO \u22642\u00a0mm\u00a0Hg\/L per minute, yet 23% demonstrated an exercise PP\/PAWP &gt;2.5. Among patients with a \u0394mPAP\/\u0394CO &gt;3.2\u00a0WU, 37% had an exercise PP\/PAWP &gt;2.5 split between \u0394PAWP\/\u0394CO groups. Patients with normal hemodynamic classification declined from 52% at rest to 36% with exercise.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The addition of PP\/PAWP to classify exercise hemodynamics uncovers previously unrecognized abnormal phenotypes within each \u0394mPAP\/\u0394CO group. Our study refines abnormal exercise hemodynamic phenotypes based on an understanding of the interrelationship between PA and left heart filling pressures.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.016339","type":"journal-article","created":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T09:59:57Z","timestamp":1604656797000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Normal and Abnormal Relationships of Pulmonary Artery to Wedge Pressure During Exercise"],"prefix":"10.1161","volume":"9","author":[{"given":"Robert F.","family":"Bentley","sequence":"first","affiliation":[{"name":"Division of Cardiology Mount Sinai Hospital, Sinai Health Toronto Ontario Canada"},{"name":"Faculty of Kinesiology and Physical Education University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1334-5943","authenticated-orcid":false,"given":"Madeleine","family":"Barker","sequence":"additional","affiliation":[{"name":"Division of Cardiology Mount Sinai Hospital, Sinai Health Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Esfandiari","sequence":"additional","affiliation":[{"name":"Division of Cardiology Mount Sinai Hospital, Sinai Health Toronto Ontario Canada"},{"name":"Institute of Medical Science University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Wright","sequence":"additional","affiliation":[{"name":"Division of Cardiology Mount Sinai Hospital, Sinai Health Toronto Ontario Canada"},{"name":"School of Health and Exercise Sciences University of British Columbia Kelowna British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe H.","family":"Valle","sequence":"additional","affiliation":[{"name":"Division of Cardiology Mount Sinai Hospital, Sinai Health Toronto Ontario Canada"},{"name":"Division of Cardiology St. Michael\u2019s Hospital, Unity Health Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Granton","sequence":"additional","affiliation":[{"name":"Institute of Medical Science University of Toronto Ontario Canada"},{"name":"Division of Respirology University Health Network Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2193-602X","authenticated-orcid":false,"given":"Susanna","family":"Mak","sequence":"additional","affiliation":[{"name":"Division of Cardiology Mount Sinai Hospital, Sinai Health Toronto Ontario Canada"},{"name":"Institute of Medical Science University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01913-2018"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26888"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.117.004750","article-title":"Pulmonary capillary wedge pressure patterns during exercise predict exercise capacity and incident heart failure","author":"Eisman AS","year":"2018","unstructured":"Eisman AS, Shah RV, Dhakal BP, Pappagianopoulos PP, Wooster L, Bailey C, Cunningham TF, Hardin KM, Baggish AL, Ho JE, et al. Pulmonary capillary wedge pressure patterns during exercise predict exercise capacity and incident heart failure. Circ Heart Fail. 2018;e004750. DOI: 10.1161\/CIRCH\u200bEARTF\u200bAILURE.117.004750.","journal-title":"Circ Heart Fail"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201211-2090CI"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.01.022"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00074312"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.34.3.377"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.051540"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1113\/JP271788"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13239-010-0027-1"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000001227"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308592"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqm162"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199206000-00002"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01897-2018"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1413687"},{"key":"e_1_3_2_18_2","first-page":"265","article-title":"Canadian normative data for the SF\u201036 health survey. Canadian Multicentre Osteoporosis Study Research Group","author":"Hopman WM","year":"2000","unstructured":"Hopman WM, Towheed T, Anastassiades T, Tenenhouse A, Poliquin S, Berger C, Joseph L, Brown JP, Murray TM, Adachi JD, et al. Canadian normative data for the SF\u201036 health survey. Canadian Multicentre Osteoporosis Study Research Group. CMAJ. 2000;265\u2013271.","journal-title":"CMAJ"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00578-2017"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201509-599FR"},{"key":"e_1_3_2_21_2","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.116.003025","article-title":"Transcatheter interatrial shunt device for the treatment of heart failure: rationale and design of the randomized trial to REDUCE Elevated Left Atrial Pressure in Heart Failure (REDUCE LAP\u2010HF I)","author":"Feldman T","year":"2016","unstructured":"Feldman T, Komtebedde J, Burkhoff D, Massaro J, Maurer MS, Leon MB, Kaye D, Silvestry FE, Cleland JG, Kitzman D, et al. Transcatheter interatrial shunt device for the treatment of heart failure: rationale and design of the randomized trial to REDUCE Elevated Left Atrial Pressure in Heart Failure (REDUCE LAP\u2010HF I). Circ Heart Fail. 2016;e003025. DOI: 10.1161\/CIRCH\u200bEARTF\u200bAILURE.116.003025.","journal-title":"Circ Heart Fail"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.109.930701"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.120.016339","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:48:19Z","timestamp":1715600899000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.120.016339"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,17]]},"references-count":21,"journal-issue":{"issue":"22","published-print":{"date-parts":[[2020,11,17]]}},"alternative-id":["10.1161\/JAHA.120.016339"],"URL":"https:\/\/doi.org\/10.1161\/jaha.120.016339","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,17]]},"assertion":[{"value":"2020-03-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-29","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e016339"}}