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Abstract Background World Symposium on Pulmonary Hypertension (WSPH) Group 2 pulmonary hypertension (PH) is a clinically integrated phenotype attributed to left heart disease, whereas pre- versus post-capillary classification is operationalized primarily by pulmonary capillary wedge pressure (PCWP). Although current recommendations emphasize contextual interpretation and provocative testing for intermediate PCWP values, the relationship between PCWP-based classification and underlying phenotype has not been systematically evaluated. We aim to quantify phenotype–hemodynamic discordance across the PCWP spectrum and evaluate a staged physiology-guided framework incorporating inhaled nitric oxide (iNO), ventricular geometry, and provocative testing. Methods We studied 1,032 participants from the NHLBI-sponsored PVDOMICS cohort with multidisciplinary adjudicated phenotypes integrating clinical, imaging, physiologic, and hemodynamic data. Stage-specific PCWP thresholds classified pre- versus post-capillary physiology at rest, during iNO, and during provocation (fluid challenge or invasive cardiopulmonary exercise testing [iCPET]). Echocardiographic right ventricular-to-left ventricular (RV/LV) ratio was evaluated as a marker of ventricular interdependence. Restricted cubic spline and staged concordance analyses defined certainty-based PCWP ranges and incremental diagnostic yield. Results Adjudicated Group 2 PH was present in 37.0% of participants. Resting PCWP demonstrated good discrimination (AUC 0.86), but substantial bidirectional phenotype–hemodynamic discordance persisted across intermediate PCWP ranges. At a resting PCWP of 12 mmHg, 25% of participants classified as pre-capillary had adjudicated Group 2 PH, whereas at 18 mmHg, 35% classified as post-capillary remained discordant non–Group 2. Concordance did not approach 90% until PCWP values were <9 mmHg or >24 mmHg. Dynamic testing incrementally improved concordance within these overlap zones. Nearly half of adjudicated Group 2 PH participants (46.5%) were not identified by resting PCWP alone; incorporation of iNO and provocative testing increased cumulative Group 2 identification by 63.4% and improved sensitivity from 79.9% to 83.7%. Model discrimination improved from an AUC of 0.863 to 0.908 (likelihood-ratio P<0.001). iNO increased PCWP in discordant Pre/G2 participants, unmasking latent left-sided limitation, while lowering PCWP in discordant Post/NonG2 participants, consistent with ventricular interdependence. RV/LV ratio ≥0.94 reduced discordant Post/NonG2 classification by 70.5%, and incorporation of PCWP/cardiac output slope improved physiologic specificity during exercise. Conclusions Group 2 PH is a dynamic, load-dependent phenotype inadequately characterized by resting PCWP alone. Intermediate PCWP values represent continuous probabilities of bidirectional discordance rather than discrete diagnostic states. A staged physiology-guided approach integrating iNO, ventricular geometry, and provocative testing improves concordance between hemodynamic classification and clinically integrated phenotype assignment. Clinical Perspective What Is New? In the deeply phenotyped PVDOMICS cohort, resting pulmonary capillary wedge pressure demonstrated good overall discrimination for adjudicated Group 2 (left heart disease) pulmonary hypertension, yet intermediate values frequently either concealed latent left-heart disease or overclassified patients without intrinsic left-heart disease Resting pulmonary capillary wedge pressure should be viewed as a continuous probability signal rather than a binary threshold, allowing additional physiologic testing to be targeted according to the degree of diagnostic uncertainty a clinician is willing to accept. A staged physiology-guided approach incorporating inhaled nitric oxide, ventricular geometry, and provocative testing improved concordance with adjudicated PH category and pre or post-capillary classification. What Are the Clinical Implications? Pre- versus post-capillary classification should be interpreted within the broader clinical and physiologic context rather than relying on a single resting pulmonary capillary wedge pressure threshold. Intermediate pulmonary capillary wedge pressure values should prompt consideration of additional physiologic evaluation, with inhaled nitric oxide providing a practical intermediate step and provocative testing providing the greatest incremental diagnostic yield. Exercise pulmonary capillary wedge pressure/cardiac output slope and markers of ventricular interdependence may provide complementary information for resolving uncertainty when resting and dynamic hemodynamics are discordant.

The primary aim of this study was to examine pitching performance metrics before and after ulnar collateral ligament reconstruction (UCLR) among Major League Baseball (MLB) starting and relief pitchers. The following information was extracted from the “Tommy John Surgery List” database regarding UCLR surgeries among MLB pitchers: UCLR date, pitcher type (starting pitcher, relief pitcher), and age at time of UCLR. Pitching performance metrics were extracted from the Baseball Savant online platform for the two seasons immediately prior to UCLR (pre) and the two seasons immediately following returning to pitching after UCLR (post). Fifty-nine pitchers were included in this study (29 starting pitchers, 30 relief pitchers). The outcome measures included the number of pitches thrown, earned run average (ERA), walks plus hits per inning pitched (WHIP), strikeout percentage, whiff percentage, walk percentage, batting average against, ground ball percentage, and fastball velocity. There was a pitcher type-by-time interaction effect for ERA (p = 0.01; η2 = 0.12) and WHIP (p = 0.01; η2 = 0.12). Starting pitcher ERA increased from 3.68 to 4.40 from pre- to post-surgery, while relief pitcher ERA decreased from 4.47 to 3.90. In addition, starting pitcher WHIP increased from 1.22 to 1.29 from pre- to post-surgery, while relief pitcher WHIP decreased from 1.38 to 1.28. There was a main effect of time for pitches thrown (p = 0.04; η2 = 0.07). Significant differences between starting and relief pitchers were observed for changes in ERA and WHIP following UCLR, whereas no pitcher type-by-time interactions were observed for the remaining performance metrics. Both starting and relief pitchers threw fewer pitches following UCLR, while fastball velocity and other key pitching performance metrics remained largely unchanged.

PURPOSE Cancer survivors endure costly and time-intensive care throughout treatment and survivorship. Paid sick leave provides employment and financial stability while supporting time off for medical needs. We investigated whether paid sick leave is associated with financial hardship and overall and cancer-specific mortality risk in working adult cancer survivors. METHODS Working adults age 18-64 years with a cancer history were identified from the National Health Interview Survey (NHIS) between 2011 and 2023. Associations of paid sick leave and financial hardship (medical care delays, problems paying medical bills, worry about paying medical bills, and cost-related medication underuse) were examined with 2011-2018 and 2019-2023 data using separate multivariable logistic regressions because of survey redesign in 2019. Linked mortality files from the National Death Index were available for 2011-2018 respondents. The association of paid sick leave and mortality risk was examined with multivariable Cox proportional hazards models. RESULTS A total of 8,091 and 3,919 working cancer survivors were identified from the 2011-2018 and 2019-2023 NHIS, respectively. Paid sick leave was associated with decreased medical care delays because of cost (2011-2018 odds ratio [OR], 0.74 [95% CI, 0.60 to 0.93]; P = .008; 2019-2023 OR, 0.51 [95% CI, 0.35 to 0.74]; P < .001) but not consistently with other forms of financial hardship. In adjusted analyses, paid sick leave was associated with significant reductions in risk of overall mortality (hazard ratio [HR], 0.74 [95% CI, 0.61 to 0.9]; P = .003) and cancer mortality (HR, 0.74 [95% CI, 0.61 to 0.91]; P = .003). CONCLUSION In working cancer survivors, paid sick leave is associated with decreased care delays and lower overall and cancer-specific mortality risk, which may be due to maintained employment, household income, and health insurance coverage leading to improvements in treatment access, affordability, and overall survivorship care.