{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:34:46Z","timestamp":1787063686409,"version":"build-2736575974"},"reference-count":40,"publisher":"European Respiratory Society (ERS)","issue":"2","license":[{"start":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T00:00:00Z","timestamp":1730937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/publications.ersnet.org\/user-licence"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["1P01HL137630"],"award-info":[{"award-number":["1P01HL137630"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K99HL164957"],"award-info":[{"award-number":["K99HL164957"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2024,10,16]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Exercise pulmonary hypertension, defined as a mean pulmonary arterial pressure (mPAP)\/cardiac output (\n                      <jats:italic>Q\u0307c<\/jats:italic>\n                      ) slope &gt;3\u2005WU during exercise, is common in patients with heart failure with preserved ejection fraction (HFpEF). However, the pulmonary gas exchange-related effects of an exaggerated exercise pulmonary hypertension (EePH) response are not well defined, especially in relation to dyspnoea on exertion and exercise intolerance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      48 HFpEF patients underwent invasive (pulmonary and radial artery catheters) constant-load (20\u2005W) and maximal incremental cycle testing. Haemodynamic measurements (mPAP and\n                      <jats:italic>Q\u0307c<\/jats:italic>\n                      ), arterial blood and expired gases, and ratings of perceived breathlessness (Borg 0\u201310 scale) were obtained. The mPAP\/\n                      <jats:italic>Q\u0307c<\/jats:italic>\n                      slope was calculated from rest to 20\u2005W. Those with a mPAP\/\n                      <jats:italic>Q\u0307c<\/jats:italic>\n                      slope \u22654.2 (median) were classified as HFpEF+EePH (n=24) and those with a mPAP\/\n                      <jats:italic>Q\u0307c<\/jats:italic>\n                      slope &lt;4.2 were classified as HFpEF (without EePH) (n=24). The alveolar\u2013arterial oxygen tension difference, dead space to tidal volume ratio (Bohr equation) and the minute ventilation to carbon dioxide production slope (from rest to 20\u2005W) were calculated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Arterial oxygen tension was lower (p=0.03) and dead space to tidal volume ratio was higher (p=0.03) at peak exercise in HFpEF+EePH than in HFpEF. The alveolar\u2013arterial oxygen tension difference was similar at peak exercise between groups (p=0.14); however, patients with HFpEF+EePH achieved the peak alveolar\u2013arterial oxygen tension difference at a lower peak work rate (p&lt;0.01). The minute ventilation to carbon dioxide production slope was higher in HFpEF+EePH than in HFpEF (p=0.01). Perceived breathlessness was \u22651 unit higher at 20\u2005W and peak oxygen uptake was lower (p&lt;0.01) in HFpEF+EePH than in HFpEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These data suggest that EePH contributes to pulmonary gas exchange impairments during exercise by causing a ventilation\/perfusion mismatch that provokes both ventilatory inefficiency and hypoxaemia, both of which seem to contribute to dyspnoea on exertion and exercise intolerance in patients with HFpEF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/13993003.00722-2024","type":"journal-article","created":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T11:10:23Z","timestamp":1730977823000},"page":"2400722","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Pulmonary gas exchange in relation to exercise 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