TY - JOUR
T1 - Exertional Cardiac and Pulmonary Vascular Hemodynamics in Patients With Heart Failure With Reduced Ejection Fraction
AU - EDWARD, JUSTIN A.
AU - PARKER, H. U.G.H.
AU - STÖHR, ERIC J.
AU - MCDONNELL, BARRY J.
AU - O'GEAN, KATIE
AU - SCHULTE, MARGARET
AU - LAWLEY, JUSTIN S.
AU - CORNWELL, WILLIAM K.
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/9
Y1 - 2023/9
N2 - Background: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF), but quantitative data regarding exertional hemodynamics are lacking. Objectives: We sought to characterize exertional cardiopulmonary hemodynamics in patients with HFrEF. Methods: We studied 35 patients with HFrEF (59 ± 12 years old, 30 males) who completed invasive cardiopulmonary exercise testing. Data were collected at rest, at submaximal exercise and at peak effort on upright cycle ergometry. Cardiovascular and pulmonary vascular hemodynamics were recorded. Fick cardiac output (Qc) was determined. Hemodynamic predictors of peak oxygen uptake (VO2) were identified. Results: Left ventricular ejection fraction and cardiac index were 23% ± 8% and 2.9 ± 1.1 L/min/m2, respectively. Peak VO2 was 11.8 ± 3.3 mL/kg/min, and the ventilatory efficiency slope was 53 ± 13. Right atrial pressure increased from rest to peak exercise (4 ± 5 vs 7 ± 6 mmHg,). Mean pulmonary arterial pressure increased from rest to peak exercise (27 ± 13 vs 38 ± 14 mmHg). Pulmonary artery pulsatility index increased from rest to peak exercise, while pulmonary arterial capacitance and pulmonary vascular resistance declined. Conclusions: Patients with HFrEF suffer from marked increases in filling pressures during exercise. These findings provide new insight into cardiopulmonary abnormalities contributing to impairments in exercise capacity in this population. Clinical Trial Registration: clinicaltrials.gov
AB - Background: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF), but quantitative data regarding exertional hemodynamics are lacking. Objectives: We sought to characterize exertional cardiopulmonary hemodynamics in patients with HFrEF. Methods: We studied 35 patients with HFrEF (59 ± 12 years old, 30 males) who completed invasive cardiopulmonary exercise testing. Data were collected at rest, at submaximal exercise and at peak effort on upright cycle ergometry. Cardiovascular and pulmonary vascular hemodynamics were recorded. Fick cardiac output (Qc) was determined. Hemodynamic predictors of peak oxygen uptake (VO2) were identified. Results: Left ventricular ejection fraction and cardiac index were 23% ± 8% and 2.9 ± 1.1 L/min/m2, respectively. Peak VO2 was 11.8 ± 3.3 mL/kg/min, and the ventilatory efficiency slope was 53 ± 13. Right atrial pressure increased from rest to peak exercise (4 ± 5 vs 7 ± 6 mmHg,). Mean pulmonary arterial pressure increased from rest to peak exercise (27 ± 13 vs 38 ± 14 mmHg). Pulmonary artery pulsatility index increased from rest to peak exercise, while pulmonary arterial capacitance and pulmonary vascular resistance declined. Conclusions: Patients with HFrEF suffer from marked increases in filling pressures during exercise. These findings provide new insight into cardiopulmonary abnormalities contributing to impairments in exercise capacity in this population. Clinical Trial Registration: clinicaltrials.gov
KW - Exercise
KW - Heart failure with reduced ejection fraction
KW - Hemodynamics
KW - Pulmonary vascular disease
UR - http://www.scopus.com/inward/record.url?scp=85152965510&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2023.01.010
DO - 10.1016/j.cardfail.2023.01.010
M3 - Article
C2 - 36871613
AN - SCOPUS:85152965510
SN - 1071-9164
VL - 29
SP - 1276
EP - 1284
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 9
ER -