An official European Respiratory Society statement: pulmonary haemodynamics during exercise.

Kovacs G, Herve P, Barbera JA, Chaouat A, Chemla D, Condliffe R, Garcia G, Grünig E, Howard L, Humbert M, Lau E,
Laveneziana P, Lewis GD, Naeije R, Peacock A, Rosenkranz S, Saggar R, Ulrich S, Vizza D, Vonk Noordegraaf A,
Olschewski H.

Eur Respir J. 2017 Nov 22;50(5)
Erratum in
Eur Respir J. 2018 Jan 18;51(1):.

There is growing recognition of the clinical importance of pulmonary
haemodynamics during exercise, but several questions remain to be elucidated. The
goal of this statement is to assess the scientific evidence in this field in
order to provide a basis for future recommendations.Right heart catheterisation
is the gold standard method to assess pulmonary haemodynamics at rest and during
exercise. Exercise echocardiography and cardiopulmonary exercise testing
represent non-invasive tools with evolving clinical applications. The term
“exercise pulmonary hypertension” may be the most adequate to describe an
abnormal pulmonary haemodynamic response characterised by an excessive pulmonary
arterial pressure (PAP) increase in relation to flow during exercise. Exercise
pulmonary hypertension may be defined as the presence of resting mean PAP
<25 mmHg and mean PAP >30 mmHg during exercise with total pulmonary resistance
>3 Wood units. Exercise pulmonary hypertension represents the haemodynamic
appearance of early pulmonary vascular disease, left heart disease, lung disease
or a combination of these conditions. Exercise pulmonary hypertension is
associated with the presence of a modest elevation of resting mean PAP and
requires clinical follow-up, particularly if risk factors for pulmonary
hypertension are present. There is a lack of robust clinical evidence on targeted
medical therapy for exercise pulmonary hypertension.