Pulmonary Capillary Wedge Pressure Patterns During Exercise Predict Exercise Capacity and Incident Heart Failure.
| Autor: | Eisman AS; Cardiology Division and the Pulmonary and Critical Care Unit of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston., Shah RV; Cardiology Division and the Pulmonary and Critical Care Unit of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston., Dhakal BP; Cardiology Division and the Pulmonary and Critical Care Unit of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston., Pappagianopoulos PP; Cardiology Division and the Pulmonary and Critical Care Unit of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston., Wooster L; Cardiology Division and the Pulmonary and Critical Care Unit of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston., Bailey C; Cardiology Division and the Pulmonary and Critical Care Unit of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston., Cunningham TF; Cardiology Division and the Pulmonary and Critical Care Unit of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston., Hardin KM; Cardiology Division and the Pulmonary and Critical Care Unit of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston., Baggish AL; Cardiology Division and the Pulmonary and Critical Care Unit of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston., Ho JE; Cardiology Division and the Pulmonary and Critical Care Unit of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston., Malhotra R; Cardiology Division and the Pulmonary and Critical Care Unit of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston., Lewis GD; Cardiology Division and the Pulmonary and Critical Care Unit of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. glewis@partners.org. |
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| Jazyk: | angličtina |
| Zdroj: | Circulation. Heart failure [Circ Heart Fail] 2018 May; Vol. 11 (5), pp. e004750. |
| DOI: | 10.1161/CIRCHEARTFAILURE.117.004750 |
| Abstrakt: | Background: Single measurements of left ventricular filling pressure at rest lack sensitivity for identifying heart failure with preserved ejection fraction (HFpEF) in patients with dyspnea on exertion. We hypothesized that exercise hemodynamic measurements (ie, changes in pulmonary capillary wedge pressure [PCWP] indexed to cardiac output [CO]) may more sensitively differentiate HFpEF and non-HFpEF disease states, reflect aerobic capacity, and forecast heart failure outcomes in individuals with normal PCWP at rest. Methods and Results: We studied 175 patients referred for cardiopulmonary exercise testing with hemodynamic monitoring: controls (n=33), HFpEF with resting PCWP≥15 mm Hg (n=32), and patients with dyspnea on exertion with normal resting PCWP and left ventricular ejection fraction (DOE-nlrW; n=110). Across 1835 paired PCWP-CO measurements throughout exercise, we used regression techniques to define normative bounds of "PCWP/CO slope" in controls and tested the association of PCWP/CO slope with exercise capacity and composite cardiac outcomes (defined as cardiac death, incident resting PCWP elevation, or heart failure hospitalization) in the DOE-nlrW group. Relative to controls (PCWP/CO slope, 1.2±0.4 mm Hg/L/min), patients with HFpEF had a PCWP/CO slope of 3.4±1.9 mm Hg/L/min. We used a threshold (2 SD above the mean in controls) of 2 mm Hg/L/min to define abnormal. PCWP/CO slope >2 in DOE-nlrW patients was common (n=45/110) and was associated with reduced peak Vo Conclusions: Elevated PCWP/CO slope during exercise (>2 mm Hg/L/min) is common in DOE-nlrW and predicts exercise capacity and heart failure outcomes. These findings suggest that current definitions of HFpEF based on single measures during rest are insufficient and that assessment of exercise PCWP/CO slope may refine early HFpEF diagnosis. (© 2018 American Heart Association, Inc.) |
| Databáze: | MEDLINE |
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