Pre- and post-capillary exercise contributions to pulmonary hypertension in older adults
Bibliographic record
Abstract
ABSTRACT Background Diagnosing pulmonary arterial hypertension (PAH) versus pulmonary hypertension associated with left hear disease (PH-LHD) can be challenging in patients with risk factors for both conditions. When resting pulmonary artery wedge pressure (PAWP) is proximate to a threshold of 15mmHg, exercise has been recommended to differentiate pre- versus post-capillary contributions to PH. To improve our understanding of this practice recommendation, we studied relationships between resting PAWP and the balance of pre- and post-capillary contributions to exercise PH. Methods Patients suspected of PAH (n=29, 72±2y, 52% F) with risk factors for LHD were prospectively recruited to undergo cycle ergometry at time of diagnostic right-heart catheterization. Hemodynamic data, including pressure-flow slopes and contributions of transpulmonary gradient (TPG) and PAWP to mPAP, were analyzed to evaluate pre- and post-capillary contributions, respectively, at rest and during exercise. Results PAWP ranged from 0 to 20 mmHg. Exercise pressure-flow slopes demonstrated 62% with post-capillary PH, and 31% with pre-capillary PH only. The relationship between resting PAWP and the pre- versus post-capillary contributions to exercise PH was not straightforward. Of patients with PAWP<12mmHg, 67% had post-capillary contributions to exercise PH. Conversely, 50% of patients with PAWP>15mmHg had pre-capillary contributions to exercise PH. Exercise-associated increases in pulmonary artery pressures were more strongly associated with pre-capillary contributions regardless of post-capillary contributions or the value of resting PAWP. Conclusion In this population, post-capillary contributions to exercise PH were commonly disclosed over a range of resting PAWP, including <12mmHg. The severity of exercise PH was determined by the pre-capillary contributions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".