Normal and Abnormal Relationships of Pulmonary Artery to Wedge Pressure During Exercise

Figure 1. Phenotype classification approach. A, Healthy control cohort 95% confidence limit upper threshold identification. B, Algorithmic classification approach in BREATH (Breathlessness Revealed Using Exercise to Assess the Hemodynamic Response) cohort. CO indicates cardiac output; mPAP, mean pulmonary artery pressure; PAH, pulmonary arterial hypertension; PH‐LHD, pulmonary hypertension due to left heart disease; and PP/PAWP, pulse pressure/pulmonary artery wedge pressure.

Figure 2. Individual total pulmonary resistance (TPR) slope from semiupright rest to steady state submaximal exercise. A, Healthy control cohort. B, BREATH (Breathlessness Revealed Using Exercise to Assess the Hemodynamic Response) cohort. TPR slope of 3 WU is denoted within each panel. CO indicates cardiac output; and mPAP, mean pulmonary artery pressure.

Figure 3. Coupling of the change in end‐expiratory pulmonary artery wedge pressure (PAWP) to cardiac output (CO) from semiupright rest to steady state submaximal exercise in the BREATH (Breathlessness Revealed Using Exercise to Assess the Hemodynamic Response) cohort. ΔPAWP/ΔCO of 2 mm Hg/L per minute is denoted. CO indicates cardiac output; mPAP, mean pulmonary artery pressure; PAWP, pulmonary artery wedge pressure; and WU, Wood unit.

Figure 4. Frequency distribution of pulmonary artery pulse pressure (PP) to end‐expiratory pulmonary artery wedge pressure (PAWP; PP/PAWP) during semiupright rest and during steady state submaximal exercise. A, Healthy control cohort. B, BREATH (Breathlessness Revealed Using Exercise to Assess the Hemodynamic Response) cohort ΔmPAP/ΔCO ≤3.2 WU. C, BREATH cohort ΔmPAP/ΔCO >3.2 WU. D, BREATH cohort ΔmPAP/ΔCO >3.2 WU expanded PP/PAWP axis. Vertical dashed lines represent the upper limit of normal (2.5) in each panel. CO indicates cardiac output; mPAP, mean pulmonary artery pressure; and WU, Wood unit

Figure 5. Coupling of the exercise pulmonary artery pulse pressure (PP) over end‐expiratory pulmonary artery wedge pressure (PAWP; PP/PAWP) to the change in PAWP over cardiac output (CO; ΔPAWP/ΔCO) from semiupright rest to steady state submaximal exercise. A, BREATH (Breathlessness Revealed Using Exercise to Assess the Hemodynamic Response) cohort. B, Healthy control cohort and BREATH cohort ΔmPAP/ΔCO ≤3.2 WU. Horizontal dashed line represents the upper limit of normal for Ex PP/PAWP (2.5). Vertical dashed line represents the upper limit of normal for ΔPAWP/ΔCO (2 mm Hg/L per minute). CO indicates cardiac output; mPAP, mean pulmonary artery pressure; and WU, Wood unit

Figure 6. Resting and exercise hemodynamic phenotypes within the BREATH (Breathlessness Revealed Using Exercise to Assess the Hemodynamic Response) cohort. A, BREATH cohort ΔmPAP/ΔCO ≤3.2 WU. B, BREATH cohort ΔmPAP/ΔCO >3.2 WU. Numerical representation of patients within each phenotype is denoted on each panel. Exercise phenotypes have variability introduced into the y‐axis variable to allow for delineation of individual responses from rest to exercise. CO indicates cardiac output; mPAP, mean pulmonary artery pressure; PAH, pulmonary arterial hypertension; PH‐LHD, pulmonary hypertension due to left heart disease; and WU, Wood unit