Disproportionate exercise‐induced pulmonary hypertension in relation to cardiac output in heart failure with preserved ejection fraction: a non‐invasive echocardiographic study

Aims Pulmonary hypertension (PH) and pulmonary vascular remodelling are common in patients with heart failure with preserved ejection fraction (HFpEF). Many patients with HFpEF demonstrate an abnormal pulmonary haemodynamic response to exercise that is not identifiable at rest. This can be estimated...

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Vydáno v:European journal of heart failure Ročník 25; číslo 6; s. 792 - 802
Hlavní autoři: Saito, Yuki, Obokata, Masaru, Harada, Tomonari, Kagami, Kazuki, Sorimachi, Hidemi, Yuasa, Naoki, Kato, Toshimitsu, Wada, Naoki, Okumura, Yasuo, Ishii, Hideki
Médium: Journal Article
Jazyk:angličtina
Vydáno: Oxford, UK John Wiley & Sons, Ltd 01.06.2023
Témata:
Cardiac Output
Echocardiography - methods
Exercise capacity
Exercise Test
Heart Failure
Heart failure with preserved ejection fraction
Humans
Hypertension, Pulmonary - diagnostic imaging
Hypertension, Pulmonary - etiology
Pulmonary hypertension
Pulmonary vasodilatation
Stroke Volume - physiology
Ventricular Function, Left - physiology
Heart failure with preserved ejection fraction
Exercise capacity
Pulmonary vasodilatation
Pulmonary hypertension
ISSN:1388-9842, 1879-0844, 1879-0844
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Shrnutí:Aims Pulmonary hypertension (PH) and pulmonary vascular remodelling are common in patients with heart failure with preserved ejection fraction (HFpEF). Many patients with HFpEF demonstrate an abnormal pulmonary haemodynamic response to exercise that is not identifiable at rest. This can be estimated non‐invasively by the mean pulmonary artery pressure–cardiac output relationship (mPAP/CO slope). We sought to characterize the pathophysiology of disproportionate exercise‐induced PH in relation to CO (DEi‐PH) and its prognostic impact in patients with HFpEF. Methods and results A total of 345 patients (166 HFpEF and 179 controls) underwent ergometry exercise stress echocardiography with simultaneous expired gas analysis. DEi‐PH was defined as the mPAP/CO slope >5.2 mmHg/L/min (median value). At rest, there were no differences in right ventricular (RV) function and severity of PH between HFpEF patients with and without DEi‐PH. Compared with controls (n = 179) and HFpEF without DEi‐PH (n = 83), HFpEF with DEi‐PH (n = 83) demonstrated worse exercise capacity (lower peak oxygen consumption), depressed RV systolic function, impaired RV–pulmonary artery coupling, limitation in CO augmentation, more right‐sided congestion, and worse ventilatory efficiency (higher minute ventilation vs. carbon dioxide volume) during peak exercise. Kaplan–Meier analyses showed that HFpEF patients with DEi‐PH had higher rates of composite outcomes of all‐cause mortality or heart failure events than those without (log‐rank p = 0.0002). Conclusion Patients with HFpEF and DEi‐PH demonstrated distinct pathophysiologic features that become apparent only during exercise. These data suggest that DEi‐PH is a pathophysiologic phenotype of HFpEF and reinforce the importance of exercise stress echocardiography for detailed characterization of HFpEF. Pathophysiologic features of disproportionate exercise‐induced pulmonary hypertension in heart failure with preserved ejection fraction. CO, cardiac output; DEi‐PH, disproportionate exercise‐induced pulmonary hypertension; HFpEF, heart failure with preserved ejection fraction; mPAP, mean pulmonary artery pressure; PA, pulmonary artery; PH, pulmonary hypertension; RV, right ventricular.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1388-9842
1879-0844
1879-0844
DOI:10.1002/ejhf.2821