- •Quantitative data regarding impact of exercise hemodynamic on functional capacity among patients with heart failure with reduced ejection fraction are lacking.
- •HFrEF patients experience marked increases in right- and left-sided filling pressures, as well as pul arterial pressures, during exercise, in addition to abnormal ventilatory parameters of exercise.
Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF) but quantitative data regarding exertional hemodynamics are lacking.
Characterize exertional cardiopulmonary hemodynamics in patients with HFrEF.
Thirty-five HFrEF patients (59±12 years, 30 males) completed invasive cardiopulmonary exercise testing (CPET). Data were collected at rest, submaximal exercise and 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.
Left ventricular ejection fraction and cardiac index were 23±8% and 2.9±1.1 L/min/m2, respectively. PeakVO2 was 11.8±3.3 ml/kg/min and ventilatory efficiency slope was 53±13. Right atrial pressure increased from rest to peak exercise (4±5 v. 7±6mmHg,). Mean pulmonary arterial pressure increased from rest to peak exercise (27±13 v. 38±14mmHg). Pulmonary artery pulsatility index increased from rest to peak exercise, while pulmonary arterial capacitance and pulmonary vascular resistance declined.
HFrEF patients 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 identifier: NCT03078972
Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF). In this analysis, resting and exertional hemodynamics are analyzed from a contemporary cohort of patients with HFrEF (59±12 years, left ventricular ejection fraction 23±8%) during invasive cardiopulmonary exercise testing with upright cycle ergometry. During submaximal and peak exercise, large increases in left- and right-sided filling pressures were demonstrated. Maximal oxygen uptake was severely reduced and ventilatory efficiency was severely elevated. Multiple pulmonary vascular and right-sided hemodynamic parameters were predictive of functional capacity.
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Justin A. Edward
Accepted: January 30, 2023
Received in revised form: January 27, 2023
Received: October 28, 2022
Publication stageIn Press Journal Pre-Proof
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