Type of task force
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.
- 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.
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.
- 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.
- 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.
- 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.
- 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.
- 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.