title: Criteria for diagnosis of exercise pulmonary hypertension.
abstract: The previous definition of exercise pulmonary hypertension (PH) with a mean pulmonary artery pressure (mPAP) >30 mmHg was abandoned because healthy individuals can exceed this threshold at high cardiac output (CO). We hypothesised that incorporating assessment of the pressure-flow relationship using the mPAP/CO ratio, i.e. total pulmonary resistance (TPR), might enhance the accuracy of diagnosing an abnormal exercise haemodynamic response.Exercise haemodynamics were evaluated in 169 consecutive subjects with normal resting mPAP ≤20 mmHg. Subjects were classified into controls without heart or lung disease (n=68) versus patients with pulmonary vascular disease (PVD) (n=49) and left heart disease (LHD) (n=52).TPR and mPAP at maximal exercise produced diagnostic accuracy with area under the receiver operating curve of 0.99 and 0.95, respectively, for discriminating controls versus patients with PVD and LHD. The old criterion of mPAP >30 mmHg had sensitivity of 0.98 but specificity of 0.77. Combining maximal mPAP >30 mmHg and TPR >3 mmHg·min·L(-1) retained sensitivity at 0.93 but improved specificity to 1.0. The accuracy of the combined criteria was high across different age groups, sex, body mass index and diagnosis (PVD or LHD).Combining mPAP >30 mmHg and TPR >3 mmHg·min·L(-1) is superior to mPAP >30 mmHg alone for defining a pathological haemodynamic response of the pulmonary circulation during exercise.
authors.affiliation: Département de Chirurgie Thoracique et Vasculaire et de Transplantation Cardio-Pulmonaire, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France herveccml@gmail.com.
authors.forename: Philippe
authors.initials: P
authors.lastname: Herve
authors.affiliation: Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France Sydney Medical School, University of Sydney, Camperdown, Australia.
authors.forename: Edmund M
authors.initials: EM
authors.lastname: Lau
authors.affiliation: Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Université Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Sitbon
authors.affiliation: Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Savale
authors.affiliation: Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Université Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: David
authors.initials: D
authors.lastname: Montani
authors.affiliation: Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Godinas
authors.affiliation: Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.
authors.forename: Frederic
authors.identifier: http://orcid.org/0000-0002-4276-635X
authors.initials: F
authors.lastname: Lador
authors.affiliation: Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Jaïs
authors.affiliation: Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Parent
authors.affiliation: Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Sven
authors.initials: S
authors.lastname: Günther
authors.affiliation: Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Université Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Humbert
authors.affiliation: Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France INSERM UMR S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France Université Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: Gerald
authors.initials: G
authors.lastname: Simonneau
authors.affiliation: Département de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France Université Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Chemla
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D019540:Area Under Curve; D002302:Cardiac Output / Q000502:physiology; D016022:Case-Control Studies; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D013030:Spain; D013318:Stroke Volume; D014655:Vascular Resistance / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*