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Rapid rise in PCWP at smaller workload still observed in HF patients with normal EF
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Exercise in patients with HF with normal ejection fraction produced similar pulmonary capillary wedge pressure vs. asymptomatic control patients, but at a much smaller workload, according to the results of a new study.
The study featured patients with HF with normal ejection fraction (HFNEF, n=14) and asymptomatic controls (n=8) who underwent right-side catheterization at rest and during supine cycle ergometer exercise and echocardiography. Researchers measured resting and peak exercise (E/e´).
According to their analysis, resting pulmonary capillary wedge pressure (PCWP) in HFNEF patients and controls was the same (10 ± 4 mm Hg vs. 10 ± 4 mm Hg), but stroke volume index in patients was lower (P=.02) and systemic vascular resistance index was higher (P=.01). The peak PCWP/work rate ratio was higher in HFNEF patients vs. controls (46 ± 31 mm Hg/W/kg vs. 20 ± 9 mm Hg/W/kg; P=.03), despite peak exercise PCWP being similar between groups (23 ± 6 mm Hg vs. 20 ± 7 mm Hg; P=.31). Furthermore, peak exercise stroke volume index was lower (P=.001) and systemic vascular resistance index was higher (P=.01) in HFNEF patients vs. controls.
“We propose that HFNEF patients exhibit a rapid rise in PCWP at a much lower workload than that of age-matched controls,” researchers concluded, adding that the E/e´ septal ratio does not accurately reflect the hemodynamic changes that occur during exercise in HFNEF patients. “We suggest, therefore, that invasive hemodynamic studies with exercise are required to formally establish the pathophysiologic profile in patients with suspected HFNEF and to evaluate the effects of novel therapies.”
Walter J. Paulus, MD, PhD, with the Institute for Cardiovascular Research at VU University Medical Center in Amsterdam, wrote in an accompanying editorial that impaired left ventricular preload reserve is highly relevant to the main study findings.
“Impaired LV preload reserve and low PCWP/work rate ratio both imply that HFNEF patients operate on a steep diastolic LV pressure-volume relation, and both findings reveal the true identity of the prime suspect for exercise intolerance in HFNEF, namely, a steep diastolic LV pressure-volume relation,” he said.
For more information:
- Maeder M. J Am Coll Cardiol. 2010;56:855-863.
- Paulus W. J Am Coll Cardiol. 2010;56:864-866.