Ford et al 2020

Question 1

What was the previous (2013) definition of exercise PH?

(a) Why removed

Answer 1

mPAP > 30 with exercise

(a) Removed b/c landmark review by Kovcs et all with >1000 health patients showed mPAP with exercise averaged 37 with max exercise
- no established ULN for mPAP during exercise
- Have to compare mPAP increase to CO increase: so can consider mPAP > 30 abnormal if CO remains < 10 (aka professional athlete can def get mPAP above 30, but with accompanied increase in CO)

Question 2

TPR vs. PVR

Answer 2

Total pulmonary resistance (mPAP / CO) vs. pulmonary vascular resistance ( mPAP-PAWP / CO)

Question 3

Working single-point measurement vs. two-point measurement of exercise PH

Answer 3

Single-point: mPAP > 30 with TPR (mPAP / CO) > 3 WU

Multiple-point measurement: slope of mPAP/CO over 3

Question 4

Expected change in pulmonary vasculature response to exercise with age

(a) Age cutoff typically used

Answer 4

(a) Age 50

With age there is an expected reduction in pulmonary vascular distensibility/compliance, so cutoff for mPAP increase to meet definition is higher (33 vs. 30 in one study) with age.