Sam Esfandiari1, Emil Wolsk2, David Granton3, Lucas Azevedo3, Felipe Homem Valle3, Finn Gustafsson2, Susanna Mak4. 1. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada. 2. Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark. 3. Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada. 4. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada. Electronic address: susanna.mak@sinaihealthsystem.ca.
Abstract
BACKGROUND: The pulmonary arterial wedge pressure (PAWP) response to exercise may unmask latent heart failure with preserved ejection fraction. There remains a lack of consensus over threshold values for PAWP during exercise. A systematic review of studies examining PAWP by means of right heart catheterization at rest and during exercise in healthy individuals was performed. METHODS AND RESULTS: Relevant data derived from healthy volunteers were stratified by age (older than 40 years vs 40 years or younger) and sex. Three exercise intensities were predefined: light, moderate, and strenuous. Weighted means and weighted 95% confidence intervals (CIs) for the aggregate data were calculated. A total of 424 individuals from 32 unique studies were included, of which 19% (n = 82) were female. PAWP reached weighted mean and 95% CI values of 19 (17-21) and 17 (16-18) mm Hg at light and moderate exercise, respectively. The PAWP response to exercise was similar between men and women >40 years of age. However, exercise intensities were lower in women. CONCLUSIONS: PAWP increases during exercise, reaching up to 20 mm Hg in adults >40 years of age. Older women achieve PAWP values similar to those of older men, but at lower intensities. Findings support a threshold of at least 25 mm Hg as an absolute cutoff value for "normal" PAWP response to exercise in individuals >40 years old.
BACKGROUND: The pulmonary arterial wedge pressure (PAWP) response to exercise may unmask latent heart failure with preserved ejection fraction. There remains a lack of consensus over threshold values for PAWP during exercise. A systematic review of studies examining PAWP by means of right heart catheterization at rest and during exercise in healthy individuals was performed. METHODS AND RESULTS: Relevant data derived from healthy volunteers were stratified by age (older than 40 years vs 40 years or younger) and sex. Three exercise intensities were predefined: light, moderate, and strenuous. Weighted means and weighted 95% confidence intervals (CIs) for the aggregate data were calculated. A total of 424 individuals from 32 unique studies were included, of which 19% (n = 82) were female. PAWP reached weighted mean and 95% CI values of 19 (17-21) and 17 (16-18) mm Hg at light and moderate exercise, respectively. The PAWP response to exercise was similar between men and women >40 years of age. However, exercise intensities were lower in women. CONCLUSIONS: PAWP increases during exercise, reaching up to 20 mm Hg in adults >40 years of age. Older women achieve PAWP values similar to those of older men, but at lower intensities. Findings support a threshold of at least 25 mm Hg as an absolute cutoff value for "normal" PAWP response to exercise in individuals >40 years old.
Authors: Jan Verwerft; Frederik H Verbrugge; Guido Claessen; Lieven Herbots; Paul Dendale; Andreas B Gevaert Journal: Front Cardiovasc Med Date: 2022-02-09
Authors: Katarina Zeder; Chiara Banfi; Gregor Steinrisser-Allex; Bradley A Maron; Marc Humbert; Gregory D Lewis; Andrea Berghold; Horst Olschewski; Gabor Kovacs Journal: Eur Respir J Date: 2022-10-13 Impact factor: 33.795