BACKGROUND: When advanced, heart failure with preserved ejection fraction (HFpEF) is readily apparent. However, diagnosis of earlier disease may be challenging because exertional dyspnea is not specific for heart failure, and biomarkers and hemodynamic indicators of volume overload may be absent at rest. METHODS AND RESULTS: Patients with exertional dyspnea and ejection fraction >50% were referred for hemodynamic catheterization. Those with no significant coronary disease, normal brain natriuretic peptide assay, and normal resting hemodynamics (mean pulmonary artery pressure <25 mm Hg and pulmonary capillary wedge pressure [PCWP] <15 mm Hg) (n=55) underwent exercise study. The exercise PCWP was used to classify patients as having HFpEF (PCWP ≥25 mm Hg) (n=32) or noncardiac dyspnea (PCWP <25 mm Hg) (n=23). At rest, patients with HFpEF had higher resting pulmonary artery pressure and PCWP, although all values fell within normal limits. Exercise-induced elevation in PCWP in HFpEF was confirmed by greater increases in left ventricular end-diastolic pressure and was associated with blunted increases in heart rate, systemic vasodilation, and cardiac output. Exercise-induced pulmonary hypertension was present in 88% of patients with HFpEF and was related principally to elevated PCWP, as pulmonary vascular resistances dropped similarly in both groups. Exercise PCWP and pulmonary artery systolic pressure were highly correlated. An exercise pulmonary artery systolic pressure ≥45 mm Hg identified HFpEF with 96% sensitivity and 95% specificity. CONCLUSIONS: Euvolemic patients with exertional dyspnea, normal brain natriuretic peptide, and normal cardiac filling pressures at rest may have markedly abnormal hemodynamic responses during exercise, suggesting that chronic symptoms are related to heart failure. Earlier and more accurate diagnosis using exercise hemodynamics may allow better targeting of interventions to treat and prevent HFpEF progression.
BACKGROUND: When advanced, heart failure with preserved ejection fraction (HFpEF) is readily apparent. However, diagnosis of earlier disease may be challenging because exertional dyspnea is not specific for heart failure, and biomarkers and hemodynamic indicators of volume overload may be absent at rest. METHODS AND RESULTS:Patients with exertional dyspnea and ejection fraction >50% were referred for hemodynamic catheterization. Those with no significant coronary disease, normal brain natriuretic peptide assay, and normal resting hemodynamics (mean pulmonary artery pressure <25 mm Hg and pulmonary capillary wedge pressure [PCWP] <15 mm Hg) (n=55) underwent exercise study. The exercise PCWP was used to classify patients as having HFpEF (PCWP ≥25 mm Hg) (n=32) or noncardiac dyspnea (PCWP <25 mm Hg) (n=23). At rest, patients with HFpEF had higher resting pulmonary artery pressure and PCWP, although all values fell within normal limits. Exercise-induced elevation in PCWP in HFpEF was confirmed by greater increases in left ventricular end-diastolic pressure and was associated with blunted increases in heart rate, systemic vasodilation, and cardiac output. Exercise-induced pulmonary hypertension was present in 88% of patients with HFpEF and was related principally to elevated PCWP, as pulmonary vascular resistances dropped similarly in both groups. Exercise PCWP and pulmonary artery systolic pressure were highly correlated. An exercise pulmonary artery systolic pressure ≥45 mm Hg identified HFpEF with 96% sensitivity and 95% specificity. CONCLUSIONS: Euvolemic patients with exertional dyspnea, normal brain natriuretic peptide, and normal cardiac filling pressures at rest may have markedly abnormal hemodynamic responses during exercise, suggesting that chronic symptoms are related to heart failure. Earlier and more accurate diagnosis using exercise hemodynamics may allow better targeting of interventions to treat and prevent HFpEF progression.
Authors: M D Thomas; K F Fox; D A Wood; J S R Gibbs; A J S Coats; M Y Henein; P A Poole-Wilson; G C Sutton Journal: Heart Date: 2005-09-13 Impact factor: 5.994
Authors: Theophilus E Owan; David O Hodge; Regina M Herges; Steven J Jacobsen; Veronique L Roger; Margaret M Redfield Journal: N Engl J Med Date: 2006-07-20 Impact factor: 91.245
Authors: Frans H Rutten; Maarten-Jan M Cramer; Diederick E Grobbee; Alfred P E Sachs; Johannes H Kirkels; Jan-Willem J Lammers; Arno W Hoes Journal: Eur Heart J Date: 2005-04-28 Impact factor: 29.983
Authors: R Sacha Bhatia; Jack V Tu; Douglas S Lee; Peter C Austin; Jiming Fang; Annick Haouzi; Yanyan Gong; Peter P Liu Journal: N Engl J Med Date: 2006-07-20 Impact factor: 91.245
Authors: Francesca Bursi; Susan A Weston; Margaret M Redfield; Steven J Jacobsen; Serguei Pakhomov; Vuyisile T Nkomo; Ryan A Meverden; Véronique L Roger Journal: JAMA Date: 2006-11-08 Impact factor: 56.272
Authors: Natalia C Berry; Agarwal Manyoo; William M Oldham; Thomas E Stephens; Ronald H Goldstein; Aaron B Waxman; Julie A Tracy; Peter J Leary; Jane A Leopold; Scott Kinlay; Alexander R Opotowsky; David M Systrom; Bradley A Maron Journal: Pulm Circ Date: 2015-12 Impact factor: 3.017
Authors: Maximilian von Roeder; Johannes Tammo Kowallick; Karl-Philipp Rommel; Stephan Blazek; Christian Besler; Karl Fengler; Joachim Lotz; Gerd Hasenfuß; Christian Lücke; Matthias Gutberlet; Holger Thiele; Andreas Schuster; Philipp Lurz Journal: Clin Res Cardiol Date: 2019-05-03 Impact factor: 5.460