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Haemodynamics, dyspnoea, and pulmonary reserve in heart failure with preserved ejection fraction

Haemodynamics, dyspnoea, and pulmonary reserve in heart failure with preserved ejection fraction AimsIncreases in left ventricular filling pressure are a fundamental haemodynamic abnormality in heart failure with preserved ejection fraction (HFpEF). However, very little is known regarding how elevated filling pressures cause pulmonary abnormalities or symptoms of dyspnoea. We sought to determine the relationships between simultaneously measured central haemodynamics, symptoms, and lung ventilatory and gas exchange abnormalities during exercise in HFpEF.Methods and resultsSubjects with invasively-proven HFpEF (n = 50) and non-cardiac causes of dyspnoea (controls, n = 24) underwent cardiac catheterization at rest and during exercise with simultaneous expired gas analysis. During submaximal (20 W) exercise, subjects with HFpEF displayed higher pulmonary capillary wedge pressures (PCWP) and pulmonary artery pressures, higher Borg perceived dyspnoea scores, and increased ventilatory drive and respiratory rate. At peak exercise, ventilation reserve was reduced in HFpEF compared with controls, with greater dead space ventilation (higher V D/V T). Increasing exercise PCWP was directly correlated with higher perceived dyspnoea scores, lower peak exercise capacity, greater ventilatory drive, worse New York Heart Association (NYHA) functional class, and impaired pulmonary ventilation reserve.ConclusionThis study provides the first evidence linking altered exercise haemodynamics to pulmonary abnormalities and symptoms of dyspnoea in patients with HFpEF. Further study is required to identify the mechanisms by which haemodynamic derangements affect lung function and symptoms and to test novel therapies targeting exercise haemodynamics in HFpEF. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

Haemodynamics, dyspnoea, and pulmonary reserve in heart failure with preserved ejection fraction

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Publisher
Oxford University Press
Copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
ISSN
0195-668X
eISSN
1522-9645
DOI
10.1093/eurheartj/ehy268
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Abstract

AimsIncreases in left ventricular filling pressure are a fundamental haemodynamic abnormality in heart failure with preserved ejection fraction (HFpEF). However, very little is known regarding how elevated filling pressures cause pulmonary abnormalities or symptoms of dyspnoea. We sought to determine the relationships between simultaneously measured central haemodynamics, symptoms, and lung ventilatory and gas exchange abnormalities during exercise in HFpEF.Methods and resultsSubjects with invasively-proven HFpEF (n = 50) and non-cardiac causes of dyspnoea (controls, n = 24) underwent cardiac catheterization at rest and during exercise with simultaneous expired gas analysis. During submaximal (20 W) exercise, subjects with HFpEF displayed higher pulmonary capillary wedge pressures (PCWP) and pulmonary artery pressures, higher Borg perceived dyspnoea scores, and increased ventilatory drive and respiratory rate. At peak exercise, ventilation reserve was reduced in HFpEF compared with controls, with greater dead space ventilation (higher V D/V T). Increasing exercise PCWP was directly correlated with higher perceived dyspnoea scores, lower peak exercise capacity, greater ventilatory drive, worse New York Heart Association (NYHA) functional class, and impaired pulmonary ventilation reserve.ConclusionThis study provides the first evidence linking altered exercise haemodynamics to pulmonary abnormalities and symptoms of dyspnoea in patients with HFpEF. Further study is required to identify the mechanisms by which haemodynamic derangements affect lung function and symptoms and to test novel therapies targeting exercise haemodynamics in HFpEF.

Journal

European Heart Journal – Oxford University Press

Published: May 19, 2018

Keywords: Dyspnoea; Exercise; Heart failure; Pulmonary function

References

  • Heart failure with preserved ejection fraction
    Reddy, YN; Borlaug, BA.
  • Lung function and exercise gas exchange in chronic heart failure
    Wasserman, K; Zhang, YY; Gitt, A; Belardinelli, R; Koike, A; Lubarsky, L; Agostoni, PG.
  • Impaired pulmonary diffusion in heart failure with preserved ejection fraction
    Olson, TP; Johnson, BD; Borlaug, BA.
  • Influence of locomotor muscle metaboreceptor stimulation on the ventilatory response to exercise in heart failure
    Olson, TP; Joyner, MJ; Johnson, BD.
  • Subclinical pulmonary edema is associated with reduced exercise capacity in HFpEF and HFrEF
    Thompson, RB; Pagano, JJ; Chow, K; Sekowski, V; Paterson, I; Ezekowitz, J; Anderson, T; Dyck, JRB; Haykowsky, MJ.
  • Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction
    Borlaug, BA; Nishimura, RA; Sorajja, P; Lam, CS; Redfield, MM.
  • Role of diastolic stress testing in the evaluation for heart failure with preserved ejection fraction: a simultaneous invasive-echocardiographic study
    Obokata, M; Kane, GC; Reddy, YN; Olson, TP; Melenovsky, V; Borlaug, BA.
  • Increased exercise ventilation in patients with chronic heart failure: intact ventilatory control despite hemodynamic and pulmonary abnormalities
    Sullivan, MJ; Higginbotham, MB; Cobb, FR.
  • Relation between hemodynamic and ventilatory responses in determining exercise capacity in severe congestive heart failure
    Franciosa, JA; Leddy, CL; Wilen, M; Schwartz, DE.
  • Exercise ventilation and pulmonary artery wedge pressure in chronic stable congestive heart failure
    Fink, LI; Wilson, JR; Ferraro, N.
  • Dissociation between exertional symptoms and circulatory function in patients with heart failure
    Wilson, JR; Rayos, G; Yeoh, TK; Gothard, P; Bak, K.
  • Dissociation between peak exercise oxygen consumption and hemodynamic dysfunction in potential heart transplant candidates
    Wilson, JR; Rayos, G; Yeoh, TK; Gothard, P.
  • Determinants of ventilatory efficiency in heart failure: the role of right ventricular performance and pulmonary vascular tone
    Lewis, GD; Shah, RV; Pappagianopolas, PP; Systrom, DM; Semigran, MJ.
  • Diastolic and systolic heart failure are distinct phenotypes within the heart failure spectrum
    Borlaug, BA; Redfield, MM.
  • Abnormal right ventricular-pulmonary artery coupling with exercise in heart failure with preserved ejection fraction
    Borlaug, BA; Kane, GC; Melenovsky, V; Olson, TP.
  • Differential hemodynamic effects of exercise and volume expansion in people with and without heart failure
    Andersen, MJ; Olson, TP; Melenovsky, V; Kane, GC; Borlaug, BA.
  • Enhanced pulmonary vasodilator reserve and abnormal right ventricular: pulmonary artery coupling in heart failure with preserved ejection fraction
    Andersen, MJ; Hwang, SJ; Kane, GC; Melenovsky, V; Olson, TP; Fetterly, K; Borlaug, BA.
  • Psychophysical bases of perceived exertion
    Borg, GA.
  • Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure
    Chua, TP; Ponikowski, P; Harrington, D; Anker, SD; Webb-Peploe, K; Clark, AL; Poole-Wilson, PA; Coats, AJ.
  • Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography
    Rudski, LG; Lai, WW; Afilalo, J; Hua, L; Handschumacher, MD; Chandrasekaran, K; Solomon, SD; Louie, EK; Schiller, NB.
  • Cardiac output response to exercise in relation to metabolic demand in heart failure with preserved ejection fraction
    Abudiab, MM; Redfield, MM; Melenovsky, V; Olson, TP; Kass, DA; Johnson, BD; Borlaug, BA.
  • Mechanisms of exercise intolerance in heart failure with preserved ejection fraction: the role of abnormal peripheral oxygen extraction
    Dhakal, BP; Malhotra, R; Murphy, RM; Pappagianopoulos, PP; Baggish, AL; Weiner, RB; Houstis, NE; Eisman, AS; Hough, SS; Lewis, GD.
  • Effects of exercise on left ventricular systolic and diastolic properties in patients with heart failure and a preserved ejection fraction versus heart failure and a reduced ejection fraction
    Zile, MR; Kjellstrom, B; Bennett, T; Cho, Y; Baicu, CF; Aaron, MF; Abraham, WT; Bourge, RC; Kueffer, FJ.
  • Pathophysiology of dyspnea
    Manning, HL; Schwartzstein, RM.
  • Exercise intolerance in heart failure with preserved ejection fraction: more than a heart problem
    Upadhya, B; Haykowsky, MJ; Eggebeen, J; Kitzman, DW.
  • Long-term use of sildenafil in the therapeutic management of heart failure
    Guazzi, M; Samaja, M; Arena, R; Vicenzi, M; Guazzi, MD.
  • Factors contributing to the exercise limitation of heart failure
    Wilson, JR; Mancini, DM.
  • Limited maximal exercise capacity in patients with chronic heart failure: partitioning the contributors
    Esposito, F; Mathieu-Costello, O; Shabetai, R; Wagner, PD; Richardson, RS.
  • Exercise intolerance in HFpEF: diagnosing and ranking its causes using personalized O2 pathway analysis
    Houstis, NE; Eisman, A; Pappagianopoulos, PP; Wooster, L; Bailey, CS; Wagner, PD; Lewis, GD.
  • Mechanism of the increased ventilatory response to exercise in patients with chronic heart failure
    Buller, NP; Poole-Wilson, PA.
  • Exercise-disordered breathing in chronic heart failure
    Olson, TP; Snyder, EM; Johnson, BD.
  • Causes of breathing inefficiency during exercise in heart failure
    Woods, PR; Olson, TP; Frantz, RP; Johnson, BD.
  • Physiological dead space and arterial carbon dioxide contributions to exercise ventilatory inefficiency in patients with reduced or preserved ejection fraction heart failure
    Van Iterson, EH; Johnson, BD; Borlaug, BA; Olson, TP.
  • Mechanism of stimulation of type J pulmonary receptors
    Paintal, AS.
  • Lung congestion in chronic heart failure: haemodynamic, clinical, and prognostic implications
    Melenovsky, V; Andersen, MJ; Andress, K; Reddy, YN; Borlaug, BA.
  • Effect of increased left atrial pressure on breathing frequency in anesthetized dog
    Lloyd, TC
  • Stimulation of pulmonary vagal afferent C-fibers by lung edema in dogs
    Roberts, AM; Bhattacharya, J; Schultz, HD; Coleridge, HM; Coleridge, JC.
  • Different correlates but similar prognostic implications for right ventricular dysfunction in heart failure patients with reduced or preserved ejection fraction
    Ghio, S; Guazzi, M; Scardovi, AB; Klersy, C; Clemenza, F; Carluccio, E; Temporelli, PL; Rossi, A; Faggiano, P; Traversi, E; Vriz, O; Dini, FL.
  • 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC
    Ponikowski, P; Voors, AA; Anker, SD; Bueno, H; Cleland, JG; Coats, AJ; Falk, V; Gonzalez-Juanatey, JR; Harjola, VP; Jankowska, EA; Jessup, M; Linde, C; Nihoyannopoulos, P; Parissis, JT; Pieske, B; Riley, JP; Rosano, GM; Ruilope, LM; Ruschitzka, F; Rutten, FH; van der Meer, P.
  • 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT)
    Galie, N; Humbert, M; Vachiery, JL; Gibbs, S; Lang, I; Torbicki, A; Simonneau, G; Peacock, A; Vonk Noordegraaf, A; Beghetti, M; Ghofrani, A; Gomez Sanchez, MA; Hansmann, G; Klepetko, W; Lancellotti, P; Matucci, M; McDonagh, T; Pierard, LA; Trindade, PT; Zompatori, M; Hoeper, M; Aboyans, V; Vaz Carneiro, A; Achenbach, S; Agewall, S; Allanore, Y; Asteggiano, R; Paolo Badano, L; Albert Barbera, J; Bouvaist, H; Bueno, H; Byrne, RA; Carerj, S; Castro, G; Erol, C; Falk, V; Funck-Brentano, C; Gorenflo, M; Granton, J; Iung, B; Kiely, DG; Kirchhof, P; Kjellstrom, B; Landmesser, U; Lekakis, J; Lionis, C; Lip, GY; Orfanos, SE; Park, MH; Piepoli, MF; Ponikowski, P; Revel, MP; Rigau, D; Rosenkranz, S; Voller, H; Luis Zamorano, J.
  • Is it time to recognize a New Phenotype? Heart Failure with preserved ejection fraction with Pulmonary Vascular Disease
    Borlaug, BA; Obokata, M.