24 November 2016

Task Force Annual Report - Exercise

2016 report

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Achievements so far

At the Rome PVR meeting in January 2016, the 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:

• ePH is associated with exertional intolerance

• ePH substantively affects exercise tolerance through decreases in oxygen delivery and its peripheral utilisation

• 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.



New guidelines for standardized invasive exercise testing
Berry NC, Manyoo A, Oldham WM, Stephens TE, Goldstein RH, Waxman AB, Tracy JA, Leary PJ, Leopold JA, Kinlay S, Opotowsky AR, Systrom DM, Maron BA. Protocol for exercise hemodynamic assessment: performing an invasive cardiopulmonary exercise test in clinical practice. Pulm Circ. 2015 Dec;5(4):610-8. doi: 10.1086/683815. Review. PMID: 26697168

The first large study of the upper limits of normal for exercise pulmonary hemodynamics in a 'true' normal population
Oliveira RKF,Agarwal M,. Tracy JA, Karin AL, Opotowsky AR, Waxman AB, Systrom DM. Age-related upper limits of normal for maximum upright exercise pulmonary haemodynamics. Eur Resp J. DOI: 10.1183/13993003.01307-2015 Published 17 December 2015

A paper describing early compliance changes in precapillary exercise PH which differ from heart failure preserved ejection fraction
Oliveira RK, Waxman AB, Agarwal M, Badr Eslam R, Systrom DM. Pulmonary haemodynamics during recovery from maximum incremental cycling exercise. Eur Resp J 2016 Apr 28. pii: ERJ-00023-2016. doi: 10.1183/13993003.00023-2016. [Epub ahead of print]

Goals/Aims for 2017

• Better understand the functional relationship between borderline and exercise pulmonary hypertension

• effect of pulmonary vasodilator treatment on exercise pH

• Long term outcomes of untreated ePH

• Deep phenotyping of ePH, including imaging and transpulmonary flux of biomarkers (metabolomics, proteomics, transcriptomics and coagulomics).


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