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01-04-2022 | Heart Failure | Original Paper

Exercise hemodynamics in heart failure patients with preserved and mid-range ejection fraction: key role of the right heart

Authors: Andreas J. Rieth, Manuel J. Richter, Khodr Tello, Henning Gall, Hossein A. Ghofrani, Stefan Guth, Christoph B. Wiedenroth, Werner Seeger, Steffen D. Kriechbaum, Veselin Mitrovic, P. Christian Schulze, Christian W. Hamm

Published in: Clinical Research in Cardiology | Issue 4/2022

Abstract

Objective

We sought to explore whether classification of patients with heart failure and mid-range (HFmrEF) or preserved ejection fraction (HFpEF) according to their left ventricular ejection fraction (LVEF) identifies differences in their exercise hemodynamic profile, and whether classification according to an index of right ventricular (RV) function improves differentiation.

Background

Patients with HFmrEF and HFpEF have hemodynamic compromise on exertion. The classification according to LVEF implies a key role of the left ventricle. However, RV involvement in exercise limitation is increasingly recognized. The tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure (TAPSE/PASP) ratio is an index of RV and pulmonary vascular function. Whether exercise hemodynamics differ more between HFmrEF and HFpEF than between TAPSE/PASP tertiles is unknown.

Methods

We analyzed 166 patients with HFpEF (LVEF ≥ 50%) or HFmrEF (LVEF 40–49%) who underwent basic diagnostics (laboratory testing, echocardiography at rest, and cardiopulmonary exercise testing [CPET]) and exercise with right heart catheterization. Hemodynamics were compared according to echocardiographic left ventricular or RV function.

Results

Exercise hemodynamics (e.g. pulmonary arterial wedge pressure/cardiac output [CO] slope, CO increase during exercise, and maximum total pulmonary resistance) showed no difference between HFpEF and HFmrEF, but significantly differed across TAPSE/PASP tertiles and were associated with CPET results. N-terminal pro-brain natriuretic peptide concentration also differed significantly across TAPSE/PASP tertiles but not between HFpEF and HFmrEF.

Conclusion

In patients with HFpEF or HFmrEF, TAPSE/PASP emerged as a more appropriate stratification parameter than LVEF to predict clinically relevant impairment of exercise hemodynamics.

Graphic abstract

Stratification of exercise hemodynamics in patients with HFpEF or HFmrEF according to LVEF or TAPSE/PASP, showing significant distinctions only with the RV-based strategy. All data are shown as median [upper limit of interquartile range] and were calculated using the independent-samples Mann–Whitney U test or Kruskal–Wallis test. PVR pulmonary vascular resistance; max maximum level during exercise.

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Title: Exercise hemodynamics in heart failure patients with preserved and mid-range ejection fraction: key role of the right heart
Authors: Andreas J. Rieth
Manuel J. Richter
Khodr Tello
Henning Gall
Hossein A. Ghofrani
Stefan Guth
Christoph B. Wiedenroth
Werner Seeger
Steffen D. Kriechbaum
Veselin Mitrovic
P. Christian Schulze
Christian W. Hamm
Publication date: 01-04-2022
Publisher: Springer Berlin Heidelberg
Keyword: Heart Failure
Published in: Clinical Research in Cardiology / Issue 4/2022
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-021-01884-1

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Exercise hemodynamics in heart failure patients with preserved and mid-range ejection fraction: key role of the right heart

Abstract

Objective

Background

Methods

Results

Conclusion

Graphic abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

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Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objective

Background

Methods

Results

Conclusion

Graphic abstract

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