1. Include patients with resting mPAP<25 mmHg |
2. Brachial or jugular vein approach |
3. Dynamic exercise in supine position on bicycle |
4. Number of work step and work increment to reach the maximum within 10–15 min |
5. Successive stages: baseline supine, legs on cycle pedal, unloaded pedalling (0 W) and at constant workload increments of 10–30 W depending on estimated exercise capacity (usually 1–3 work load steps) |
6. Measurement of mPAP and PAWP averaged over the respiratory cycle and CO in triplicate using thermodilution or direct Fick method |
7. Measure mPAP, PAWP and CO at steady state at each step: i.e. unchanged mPAP and heart rate; usually during the last 2 min of each exercise step |
8. Interpretations |
If at submaximal workload, mPAP >30 mmHg with CO <10 L·min−1: (TPR >3 WU) you can stop the test: exercise PH |
If not, continue the test until maximum tolerable workload: |
If TPRmax ≤3 WU with mPAP >30 mmHg: no exercise PH |
If TPRmax ≤3 WU with mPAP ≤30 mmHg: no exercise PH |
If TPRmax >3 WU with mPAP ≤30 mmHg: no exercise PH |
If TPRmax >3 WU with mPAP >30 mmHg: exercise PH |