Does exercise pulmonary hypertension exist?
The exercise definition of pulmonary hypertension using a mean pulmonary artery pressure threshold of greater than 30 mmHg was abandoned following the 4th World Pulmonary Hypertension Symposium in 2008, as this definition was not supported by evidence and healthy individuals frequently exceed this threshold. Meanwhile, the clinical value of exercise pulmonary hemodynamic testing has also been questioned.



Recent data support the notion that an abnormal pulmonary hemodynamic response during exercise (or exercise pulmonary hypertension) is associated with symptoms and exercise limitation. Pathophysiologic mechanisms accounting for the development of exercise pulmonary hypertension include increased vascular resistance, excessive elevation in left atrial pressure and/or increased volume of trapped air during exercise, resulting in a steep rise in pulmonary artery pressure relative to cardiac output. Recent evidence suggests that exercise pulmonary hypertension may be defined by a mean pulmonary artery pressure surpassing 30 mmHg together with a simultaneous total pulmonary resistance exceeding 3 WU.



Exercise pulmonary hypertension is a clinically relevant entity and an improved definition has been suggested based on new evidence. Exercise pulmonary hemodynamics may help unmask early or latent disease, particularly in populations that are at high risk for the development of pulmonary hypertension.
aDepartment of Respiratory Medicine, Royal Prince Alfred Hospital and Sydney Medical School, University of Sydney, Camperdown, Australia bUniv. Paris-Sud, Faculté de Médecine, INSERM U_999, Le Kremlin Bicêtre, France cAP-HP, Services des Explorations Fonctionnelles, Hôpital Bicêtre, Le Kremlin Bicêtre, France dGreenlane Respiratory Services, Auckland City Hospital, Auckland, New Zealand eDepartment of Internal Medicine, Division of Pulmonology, Medical University of Graz, Ludwig Boltzmann Institute of Lung Vascular Research, Graz, Austria fDépartement de Chirurgie Thoracique, Vasculaire et de Transplantation Pulmonaire, Hôpital Marie Lannelongue, Le Plessis Robinson gFrench Referral Centre for Pulmonary Hypertension, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Edmund M
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Lau
Denis
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Chemla
Kenneth
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Whyte
Gabor
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Kovacs
Horst
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Olschewski
Philippe
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Herve
D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D017079:Exercise Tolerance; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D008168:Lung / Q000502:physiology* / Q000503:physiopathology; D012129:Respiratory Function Tests