Bullet points
- •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.
ABSTRACT
Background
Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection
fraction (HFrEF) but quantitative data regarding exertional hemodynamics are lacking.
Objectives
Characterize exertional cardiopulmonary hemodynamics in patients with HFrEF.
Methods
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.
Results
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.
Conclusions
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
Lay Summary
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.
Keywords
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Biography
Justin A. Edward
Article info
Publication history
Accepted:
January 30,
2023
Received in revised form:
January 27,
2023
Received:
October 28,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
