Document Detail


Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction.
MedLine Citation:
PMID:  20543134     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: When advanced, heart failure with preserved ejection fraction (HFpEF) is readily apparent. However, diagnosis of earlier disease may be challenging because exertional dyspnea is not specific for heart failure, and biomarkers and hemodynamic indicators of volume overload may be absent at rest.
METHODS AND RESULTS: Patients with exertional dyspnea and ejection fraction >50% were referred for hemodynamic catheterization. Those with no significant coronary disease, normal brain natriuretic peptide assay, and normal resting hemodynamics (mean pulmonary artery pressure <25 mm Hg and pulmonary capillary wedge pressure [PCWP] <15 mm Hg) (n=55) underwent exercise study. The exercise PCWP was used to classify patients as having HFpEF (PCWP ≥25 mm Hg) (n=32) or noncardiac dyspnea (PCWP <25 mm Hg) (n=23). At rest, patients with HFpEF had higher resting pulmonary artery pressure and PCWP, although all values fell within normal limits. Exercise-induced elevation in PCWP in HFpEF was confirmed by greater increases in left ventricular end-diastolic pressure and was associated with blunted increases in heart rate, systemic vasodilation, and cardiac output. Exercise-induced pulmonary hypertension was present in 88% of patients with HFpEF and was related principally to elevated PCWP, as pulmonary vascular resistances dropped similarly in both groups. Exercise PCWP and pulmonary artery systolic pressure were highly correlated. An exercise pulmonary artery systolic pressure ≥45 mm Hg identified HFpEF with 96% sensitivity and 95% specificity.
CONCLUSIONS: Euvolemic patients with exertional dyspnea, normal brain natriuretic peptide, and normal cardiac filling pressures at rest may have markedly abnormal hemodynamic responses during exercise, suggesting that chronic symptoms are related to heart failure. Earlier and more accurate diagnosis using exercise hemodynamics may allow better targeting of interventions to treat and prevent HFpEF progression.
Authors:
Barry A Borlaug; Rick A Nishimura; Paul Sorajja; Carolyn S P Lam; Margaret M Redfield
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-06-11
Journal Detail:
Title:  Circulation. Heart failure     Volume:  3     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-15     Completed Date:  2010-10-14     Revised Date:  2014-09-12    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  588-95     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Analysis of Variance
Cardiac Output / physiology
Chi-Square Distribution
Comorbidity
Diastole
Dyspnea / diagnosis,  physiopathology
Exercise Test*
Female
Heart Failure / diagnosis*,  physiopathology*
Hemodynamics*
Humans
Logistic Models
Male
Middle Aged
Pulmonary Wedge Pressure / physiology
ROC Curve
Retrospective Studies
Sensitivity and Specificity
Stroke Volume / physiology*
Grant Support
ID/Acronym/Agency:
HL 63281/HL/NHLBI NIH HHS; P01 HL 76611/HL/NHLBI NIH HHS; P01 HL076611/HL/NHLBI NIH HHS; P01 HL076611-05/HL/NHLBI NIH HHS; R01 HL063281/HL/NHLBI NIH HHS; R01 HL063281-08/HL/NHLBI NIH HHS; U01 HL 84907/HL/NHLBI NIH HHS; U01 HL084907-05/HL/NHLBI NIH HHS; UL RR024150/RR/NCRR NIH HHS; UL1 RR024150-05/RR/NCRR NIH HHS
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