{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T22:45:21Z","timestamp":1780613121858,"version":"3.54.1"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,6,6]]},"abstract":"<jats:sec id=\"jah38494-sec-0001\" sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The symptom for identification of pulmonary arterial hypertension (PAH) is dyspnea on exertion, with a concomitant decrease in exercise capacity. Even patients with hemodynamically improved PAH may have impaired exercise tolerance; however, the effect of central and peripheral factors on exercise tolerance remains unclear. We explored the factors contributing to exercise capacity and ventilatory efficiency in patients with hemodynamically normalized PAH after medical treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah38494-sec-0002\" xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In total, 82 patients with PAH (age: median 46 [interquartile range, 39\u201351] years; male:female, 23:59) and mean pulmonary arterial pressure \u226430\u2009mm\u2009Hg at rest were enrolled. The exercise capacity, indicated by the 6\u2010minute walk distance and peak oxygen consumption, and the ventilatory efficiency, indicated by the minute ventilation versus carbon dioxide output slope, were assessed using cardiopulmonary exercise testing with a right heart catheter. The mean pulmonary arterial pressure was 21 (17\u201325) mm\u2009Hg, and the 6\u2010minute walk distance was 530 (458\u2013565) m, whereas the peak oxygen consumption was 18.8 (14.8\u201321.6) mL\ua78fmin\n              <jats:sup>\u22121<\/jats:sup>\n              \ua78fkg\n              <jats:sup>\u22121<\/jats:sup>\n              . The multivariate model that best predicted 6\u2010minute walk distance included peak arterial mixed venous oxygen content difference (\u03b2=0.46,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001), whereas the best peak oxygen consumption predictors included peak cardiac output (\u03b2=0.72,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001), peak arterial mixed venous oxygen content difference (\u03b2=0.56,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001), and resting mean pulmonary arterial pressure (\u03b2=\u22120.25,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.026). The parameter that best predicted minute ventilation versus carbon dioxide output slope was the resting mean pulmonary arterial pressure (\u03b2=0.35,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.041). Quadriceps muscle strength was moderately correlated with exercise capacity (6\u2010minute walk distance; \u03c1=0.57,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001; peak oxygen consumption: \u03c1=0.56,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001) and weakly correlated with ventilatory efficiency (\u03c1\n              <jats:italic toggle=\"no\">=<\/jats:italic>\n              \u22120.32,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.007).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah38494-sec-0003\" xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Central and peripheral factors are closely related to impaired exercise tolerance in patients with hemodynamically normalized PAH.<\/jats:p>\n          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