Emil Wolsk1, David Kaye2, Jan Komtebedde3, Sanjiv J Shah4, Barry A Borlaug5, Daniel Burkhoff6, Dalane W Kitzman7, Carolyn S P Lam8, Dirk J van Veldhuisen9, Piotr Ponikowski10, Mark C Petrie11, Christian Hassager12, Jacob E Møller13, Finn Gustafsson12. 1. Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. Electronic address: wolsk@dadlnet.dk. 2. Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia. 3. DC Devices, Boston, Massachusetts. 4. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 5. Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota. 6. Cardiovascular Research Foundation, Orangeburg, New York. 7. Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. 8. National Heart Centre Singapore, Singapore, Singapore; Duke-National University of Singapore, Singapore; Department of Cardiology, University Medical Center Groningen, the Netherlands. 9. National Heart Centre Singapore, Singapore, Singapore; Duke-National University of Singapore, Singapore. 10. Department of Heart Diseases, Medical University and Centre for Heart Diseases, Military Hospital, Wrocław, Poland. 11. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom. 12. Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. 13. Department of Cardiology, Odense University Hospital, Odense, Denmark.
Abstract
OBJECTIVES: This study sought to discern which central (e.g., heart rate, stroke volume [SV], filling pressure) and peripheral factors (e.g., oxygen use by skeletal muscle, body mass index [BMI]) during exercise were most strongly associated with the presence of heart failure and preserved ejection fraction (HFpEF) as compared with healthy control subjects exercising at the same workload. BACKGROUND: The underlying mechanisms limiting exercise capacity in patients with HFpEF are not fully understood. METHODS: In patients with HFpEF (n = 108), the hemodynamic response at peak exercise was measured using right-sided heart catheterization and was compared with that in healthy control subjects (n = 42) at matched workloads to reveal hemodynamic differences that were not attributable to the workload performed. The patients studied were prospectively included in the REDUCE-LAP HF (Reduce Elevated Left Atrial Pressure in Patients With Heart Failure) trials and HemReX (Effect of Age on the Hemodynamic Response During Rest and Exercise in Healthy Humans) study. Univariable and multivariable logistic regression models were used to analyze variables associated with HFpEF versus control subjects. RESULTS: Compared with healthy control subjects, pulmonary capillary wedge pressure (PCWP) and SV were the only independent hemodynamic variables that were associated with HFpEF, a finding explaining 66% (p < 0.0001) of the difference between the groups. When relevant baseline characteristics were added to the base model, only BMI emerged as an additional independent variable, in total explaining of 90% of the differences between groups (p < 0.0001): PCWP (47%), BMI (31%), and SV (12%). CONCLUSIONS: The study identified 3 key variables (PCWP, BMI, and SV) that independently correlate with the presence of patients with HFpEF compared with healthy control subjects exercising at the same workload. Therapies that decrease left-sided heart filling pressures could improve exercise capacity and possibly prognosis.
RCT Entities:
OBJECTIVES: This study sought to discern which central (e.g., heart rate, stroke volume [SV], filling pressure) and peripheral factors (e.g., oxygen use by skeletal muscle, body mass index [BMI]) during exercise were most strongly associated with the presence of heart failure and preserved ejection fraction (HFpEF) as compared with healthy control subjects exercising at the same workload. BACKGROUND: The underlying mechanisms limiting exercise capacity in patients with HFpEF are not fully understood. METHODS: In patients with HFpEF (n = 108), the hemodynamic response at peak exercise was measured using right-sided heart catheterization and was compared with that in healthy control subjects (n = 42) at matched workloads to reveal hemodynamic differences that were not attributable to the workload performed. The patients studied were prospectively included in the REDUCE-LAP HF (Reduce Elevated Left Atrial Pressure in Patients With Heart Failure) trials and HemReX (Effect of Age on the Hemodynamic Response During Rest and Exercise in Healthy Humans) study. Univariable and multivariable logistic regression models were used to analyze variables associated with HFpEF versus control subjects. RESULTS: Compared with healthy control subjects, pulmonary capillary wedge pressure (PCWP) and SV were the only independent hemodynamic variables that were associated with HFpEF, a finding explaining 66% (p < 0.0001) of the difference between the groups. When relevant baseline characteristics were added to the base model, only BMI emerged as an additional independent variable, in total explaining of 90% of the differences between groups (p < 0.0001): PCWP (47%), BMI (31%), and SV (12%). CONCLUSIONS: The study identified 3 key variables (PCWP, BMI, and SV) that independently correlate with the presence of patients with HFpEF compared with healthy control subjects exercising at the same workload. Therapies that decrease left-sided heart filling pressures could improve exercise capacity and possibly prognosis.
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