Exertional Cardiac and Pulmonary Vascular Hemodynamics in Patients With Heart Failure With Reduced Ejection Fraction

Research output: Contribution to journalArticleResearchpeer review

Authors

  • Justin A Edward
  • Hugh Parker
  • Eric J Stöhr
  • Barry J McDonnell
  • Katie O'Gean
  • Margaret Schulte
  • Justin S Lawley
  • William K Cornwell

Research Organisations

External Research Organisations

  • University of Colorado Anschutz Medical Campus
  • Cardiff Metropolitan University
  • University of Innsbruck
  • Columbia University Irving Medical Center
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Details

Original languageEnglish
Pages (from-to)1276-1284
Number of pages9
JournalJournal of cardiac failure
Volume29
Issue number9
Early online date5 Mar 2023
Publication statusPublished - Sept 2023

Abstract

BACKGROUND: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF) but quantitative data regarding exertional hemodynamics are lacking.

OBJECTIVES: Characterize exertional cardiopulmonary hemodynamics in patients with HFrEF.

METHODS: Thirty-five HFrEF patients (59±12 years, 30 males) completed invasive cardiopulmonary exercise testing (CPET). Data were collected at rest, submaximal exercise and peak effort on upright cycle ergometry. Cardiovascular and pulmonary vascular hemodynamics were recorded. Fick cardiac output (Qc) was determined. Hemodynamic predictors of peak oxygen uptake (VO 2) were identified.

RESULTS: Left ventricular ejection fraction and cardiac index were 23±8% and 2.9±1.1 L/min/m 2, respectively. PeakVO 2 was 11.8±3.3 ml/kg/min and ventilatory efficiency slope was 53±13. Right atrial pressure increased from rest to peak exercise (4±5 v. 7±6mmHg,). Mean pulmonary arterial pressure increased from rest to peak exercise (27±13 v. 38±14mmHg). Pulmonary artery pulsatility index increased from rest to peak exercise, while pulmonary arterial capacitance and pulmonary vascular resistance declined.

CONCLUSIONS: HFrEF patients suffer from marked increases in filling pressures during exercise. These findings provide new insight into cardiopulmonary abnormalities contributing to impairments in exercise capacity in this population.

CLINICAL TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT03078972 LAY SUMMARY: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF). In this analysis, resting and exertional hemodynamics are analyzed from a contemporary cohort of patients with HFrEF (59±12 years, left ventricular ejection fraction 23±8%) during invasive cardiopulmonary exercise testing with upright cycle ergometry. During submaximal and peak exercise, large increases in left- and right-sided filling pressures were demonstrated. Maximal oxygen uptake was severely reduced and ventilatory efficiency was severely elevated. Multiple pulmonary vascular and right-sided hemodynamic parameters were predictive of functional capacity.

Keywords

    Exercise, Heart failure with reduced ejection fraction, Hemodynamics, Pulmonary vascular disease

ASJC Scopus subject areas

Cite this

Exertional Cardiac and Pulmonary Vascular Hemodynamics in Patients With Heart Failure With Reduced Ejection Fraction. / Edward, Justin A; Parker, Hugh; Stöhr, Eric J et al.
In: Journal of cardiac failure, Vol. 29, No. 9, 09.2023, p. 1276-1284.

Research output: Contribution to journalArticleResearchpeer review

Edward JA, Parker H, Stöhr EJ, McDonnell BJ, O'Gean K, Schulte M et al. Exertional Cardiac and Pulmonary Vascular Hemodynamics in Patients With Heart Failure With Reduced Ejection Fraction. Journal of cardiac failure. 2023 Sept;29(9):1276-1284. Epub 2023 Mar 5. doi: 10.1016/j.cardfail.2023.01.010
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title = "Exertional Cardiac and Pulmonary Vascular Hemodynamics in Patients With Heart Failure With Reduced Ejection Fraction",
abstract = "BACKGROUND: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF) but quantitative data regarding exertional hemodynamics are lacking.OBJECTIVES: Characterize exertional cardiopulmonary hemodynamics in patients with HFrEF.METHODS: Thirty-five HFrEF patients (59±12 years, 30 males) completed invasive cardiopulmonary exercise testing (CPET). Data were collected at rest, submaximal exercise and peak effort on upright cycle ergometry. Cardiovascular and pulmonary vascular hemodynamics were recorded. Fick cardiac output (Qc) was determined. Hemodynamic predictors of peak oxygen uptake (VO 2) were identified. RESULTS: Left ventricular ejection fraction and cardiac index were 23±8% and 2.9±1.1 L/min/m 2, respectively. PeakVO 2 was 11.8±3.3 ml/kg/min and ventilatory efficiency slope was 53±13. Right atrial pressure increased from rest to peak exercise (4±5 v. 7±6mmHg,). Mean pulmonary arterial pressure increased from rest to peak exercise (27±13 v. 38±14mmHg). Pulmonary artery pulsatility index increased from rest to peak exercise, while pulmonary arterial capacitance and pulmonary vascular resistance declined. CONCLUSIONS: HFrEF patients suffer from marked increases in filling pressures during exercise. These findings provide new insight into cardiopulmonary abnormalities contributing to impairments in exercise capacity in this population.CLINICAL TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT03078972 LAY SUMMARY: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF). In this analysis, resting and exertional hemodynamics are analyzed from a contemporary cohort of patients with HFrEF (59±12 years, left ventricular ejection fraction 23±8%) during invasive cardiopulmonary exercise testing with upright cycle ergometry. During submaximal and peak exercise, large increases in left- and right-sided filling pressures were demonstrated. Maximal oxygen uptake was severely reduced and ventilatory efficiency was severely elevated. Multiple pulmonary vascular and right-sided hemodynamic parameters were predictive of functional capacity.",
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note = "Funding Information: WKC has received funding from an NIH/NHLBI Mentored Patient-Oriented Research Career Development Award (# 1K23HLI32048-01 ) as well as the NIH/NCATS (# UL1TR002535 ), the Clinical Translational Science Institute at the University of Colorado Anschutz Medical Campus and the Department of Medicine at the University of Colorado Anschutz Medical Campus. ",
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TY - JOUR

T1 - Exertional Cardiac and Pulmonary Vascular Hemodynamics in Patients With Heart Failure With Reduced Ejection Fraction

AU - Edward, Justin A

AU - Parker, Hugh

AU - Stöhr, Eric J

AU - McDonnell, Barry J

AU - O'Gean, Katie

AU - Schulte, Margaret

AU - Lawley, Justin S

AU - Cornwell, William K

N1 - Funding Information: WKC has received funding from an NIH/NHLBI Mentored Patient-Oriented Research Career Development Award (# 1K23HLI32048-01 ) as well as the NIH/NCATS (# UL1TR002535 ), the Clinical Translational Science Institute at the University of Colorado Anschutz Medical Campus and the Department of Medicine at the University of Colorado Anschutz Medical Campus.

PY - 2023/9

Y1 - 2023/9

N2 - BACKGROUND: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF) but quantitative data regarding exertional hemodynamics are lacking.OBJECTIVES: Characterize exertional cardiopulmonary hemodynamics in patients with HFrEF.METHODS: Thirty-five HFrEF patients (59±12 years, 30 males) completed invasive cardiopulmonary exercise testing (CPET). Data were collected at rest, submaximal exercise and peak effort on upright cycle ergometry. Cardiovascular and pulmonary vascular hemodynamics were recorded. Fick cardiac output (Qc) was determined. Hemodynamic predictors of peak oxygen uptake (VO 2) were identified. RESULTS: Left ventricular ejection fraction and cardiac index were 23±8% and 2.9±1.1 L/min/m 2, respectively. PeakVO 2 was 11.8±3.3 ml/kg/min and ventilatory efficiency slope was 53±13. Right atrial pressure increased from rest to peak exercise (4±5 v. 7±6mmHg,). Mean pulmonary arterial pressure increased from rest to peak exercise (27±13 v. 38±14mmHg). Pulmonary artery pulsatility index increased from rest to peak exercise, while pulmonary arterial capacitance and pulmonary vascular resistance declined. CONCLUSIONS: HFrEF patients suffer from marked increases in filling pressures during exercise. These findings provide new insight into cardiopulmonary abnormalities contributing to impairments in exercise capacity in this population.CLINICAL TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT03078972 LAY SUMMARY: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF). In this analysis, resting and exertional hemodynamics are analyzed from a contemporary cohort of patients with HFrEF (59±12 years, left ventricular ejection fraction 23±8%) during invasive cardiopulmonary exercise testing with upright cycle ergometry. During submaximal and peak exercise, large increases in left- and right-sided filling pressures were demonstrated. Maximal oxygen uptake was severely reduced and ventilatory efficiency was severely elevated. Multiple pulmonary vascular and right-sided hemodynamic parameters were predictive of functional capacity.

AB - BACKGROUND: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF) but quantitative data regarding exertional hemodynamics are lacking.OBJECTIVES: Characterize exertional cardiopulmonary hemodynamics in patients with HFrEF.METHODS: Thirty-five HFrEF patients (59±12 years, 30 males) completed invasive cardiopulmonary exercise testing (CPET). Data were collected at rest, submaximal exercise and peak effort on upright cycle ergometry. Cardiovascular and pulmonary vascular hemodynamics were recorded. Fick cardiac output (Qc) was determined. Hemodynamic predictors of peak oxygen uptake (VO 2) were identified. RESULTS: Left ventricular ejection fraction and cardiac index were 23±8% and 2.9±1.1 L/min/m 2, respectively. PeakVO 2 was 11.8±3.3 ml/kg/min and ventilatory efficiency slope was 53±13. Right atrial pressure increased from rest to peak exercise (4±5 v. 7±6mmHg,). Mean pulmonary arterial pressure increased from rest to peak exercise (27±13 v. 38±14mmHg). Pulmonary artery pulsatility index increased from rest to peak exercise, while pulmonary arterial capacitance and pulmonary vascular resistance declined. CONCLUSIONS: HFrEF patients suffer from marked increases in filling pressures during exercise. These findings provide new insight into cardiopulmonary abnormalities contributing to impairments in exercise capacity in this population.CLINICAL TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT03078972 LAY SUMMARY: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF). In this analysis, resting and exertional hemodynamics are analyzed from a contemporary cohort of patients with HFrEF (59±12 years, left ventricular ejection fraction 23±8%) during invasive cardiopulmonary exercise testing with upright cycle ergometry. During submaximal and peak exercise, large increases in left- and right-sided filling pressures were demonstrated. Maximal oxygen uptake was severely reduced and ventilatory efficiency was severely elevated. Multiple pulmonary vascular and right-sided hemodynamic parameters were predictive of functional capacity.

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KW - Heart failure with reduced ejection fraction

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JO - Journal of cardiac failure

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