Patient selection - A patient with scleroderma was considered at high risk for PAH if one or more of the following is present:
(1) dyspnea on exertion
(2) diffuse capacity of carbon monoxide (DLco) < 60% of predicted
(3) forced vital capacity (FVC) < 70% of predicted
(4) ratio of percent of predicted FVC to percent of predicted DLco > 1.6
(5) resting right ventricular systolic pressure (RVSP) > 35 mm Hg
Screening exercise: standard Bruce protocol on a treadmill with target 85% of predicted maximum heart rate
increase in RVSP with exercise =
= (RVSP with exercise) - (RVSP at rest)
Indications for right heart catheterization - one of the following:
(1) RVSP > 40 mm Hg
(2) increase in RVSP with exercise >= 20 mm Hg
(3) RVSP < 40 mm Hg and symptomatic
A patient with a mean pulmonary arterial pressure < 25 mm Hg and pulmonary arterial occlusion pressure < 15 mm Hg underwent supine exercise with dumbbells to exhaustion or 85% of predicted maximum heart rate.
A patient was said to have exercise-induced PAH if during supine exercise:
(1) mean PAP > 30 mm Hg AND
(2) pulmonary arterial occlusion pressure < 18 mm Hg
