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Exercise Task Force

Task force leaders

David Systrom, United States

Aaron Waxman, United States

Type of task force

Disease & Speciality

Mission: To develop guidelines for: definition of exercise pulmonary hypertension (ePH); standardised cardiopulmonary exercise test administration, data collection and reporting and for deep phenotyping of ePH.

2019 Annual Report

What has been achieved/learned over the years, in particular updates during 2019 

The Exercise Task Force membership agreed on a broad framework of a consensus statement on exercise pulmonary hypertension as a disease. The document outline is as follows:

  • exercise pulmonary hypertension (ePH) is associated with exertional intolerance.
  • ePH substantively affects exercise tolerance through decreases in oxygen delivery and its peripheral utilisation.
  • the earliest manifestations of pulmonary hypertension are revealed through invasive cardiopulmonary exercise testing including changes in pulmonary vascular compliance, distensibility and right ventricular-pulmonary vascular (RV-PV) uncoupling.
  • transpulmonary flux of biomarkers suggest ePH is associated with an early vasculopathy.
  • event free survival is reduced and untreated ePH.
  • treatment of ePH with pulmonary vasodilators improves symptoms, exercise capacity and long-term outcome.

We have:

  • demonstrated a metabolomic plasma signature in ePH.1
  • demonstrated dynamic right ventricular-pulmonary vascular uncoupling by iCPET in ePH.2
  • demonstrated dynamic RV-PV uncoupling by iCPET in HFpEF.3
  • described abnormal pulmonary vascular distensibility and blood flow gradient as early findings in pulmonary arterial hypertension.4-5
  • established an international registry for ePH.
  • https://ichgcp.net/clinical-trials-registry/NCT03954574

Goals/Aims for 2020/21

  • Deep phenotyping of ePH, including imaging and transpulmonary flux of biomarkers (metabolomics, proteomics, transcriptomics and coagulomics).
  • Further research into dynamic right ventricular-pulmonary vascular uncoupling to exercise performance and long-term outcome.
  • Publication of a high impact review of exercise pulmonary hypertension.

References 

  1. Sanders JL, Han Y, Urbina MF, Systrom DM, Waxman AB. Metabolomics of exercise pulmonary hypertension are intermediate between controls and patients with pulmonary arterial hypertension. Pulm Circ. 2019 Oct 30;9(4):2045894019882623.
    doi: 10.1177/2045894019882623. eCollection 2019 Oct-Dec. PubMed PMID: 31695905; PubMed Central PMCID: PMC6822198.
  2. Singh I, Rahaghi FN, Naeije R, Oliveira RKF, Vanderpool RR, Waxman AB, Systrom
    DM. Dynamic right ventricular-pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertension.
    Pulm Circ. 2019 Jul-Sep;9(3):2045894019862435. doi: 10.1177/2045894019862435. PubMed PMID: 31218910; PubMed Central PMCID: PMC6643191. 
  3. Singh I, Rahaghi FN, Naeije R, Oliveira RKF, Systrom DM, Waxman AB. Right Ventricular-Arterial Uncoupling During Exercise in Heart Failure With Preserved Ejection Fraction: Role of Pulmonary Vascular Dysfunction. Chest. 2019 Nov;156(5):933-943. doi: 10.1016/j.chest.2019.04.109. Epub 2019 May 16. PubMed PMID: 31103695. 
  4. Singh I, Oliveira RKF, Naeije R, Rahaghi FN, Oldham WM, Systrom DM, Waxman AB. Pulmonary Vascular Distensibility and Early Pulmonary Vascular Remodeling in Pulmonary Hypertension. Chest. 2019 Oct;156(4):724-732. doi: 10.1016/j.chest.2019.04.111. Epub 2019 May 20. PubMed PMID: 31121149. 
  5. Kohli P, Kelly VJ, Kehl EG, Rodriguez-Lopez J, Hibbert KA, Kone M, Systrom DM, Waxman AB, Venegas JG, Channick R, Winkler T, Harris RS. Perfusion Imaging Distinguishes Exercise Pulmonary Arterial Hypertension at Rest. Am J Respir Crit Care Med. 2019 Jun 1;199(11):1438-1441. doi: 10.1164/rccm.201810-1899LE. PubMed PMID: 30811948.

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