Abstract 3187: Do Exercise Hemodynamics Enhance Diagnosis of Heart Failure With Preserved Ejection Fraction?
Background When advanced, heart failure with preserved ejection fraction (HFpEF) is readily apparent. Earlier disease (e.g. NYHA II) is more difficult to diagnose, as biomarkers (BNP) and volume status may appear normal at rest.
Objective Determine if exercise hemodynamic assessment identifies patients with HFpEF despite normal filling pressures and BNP at rest, and examine how exercise hemodynamics are related to metabolic performance (peak VO2).
Methods Patients with exertional dyspnea and EF>50% were referred for hemodynamic catheterization. Those with no significant coronary disease and normal resting hemodynamics (mean pulmonary artery (PA) pressure<25 mmHg & PA wedge (WP) pressure <15 mmHg; n=53) underwent exercise study. The exercise WP was used to classify patients as having HFpEF (WP≥25 mmHg; n=29) or non-cardiac dyspnea (NCD, WP<25 mmHg; n=24).
Results (Table⇓) Plasma BNP was normal in all HFpEF patients. HFpEF patients displayed higher resting PA, WP and pulmonary vascular resistance index (PVRI), though all values fell within normal limits. Exercise-induced elevation in WP in HFpEF was confirmed by increases in LV end diastolic pressure, and was associated with blunted increases in cardiac output. Exercise caused greater increase in PA pressures in HFpEF, which was related to elevated left heart pressures, as PVRI dropped similarly in each group. Exercise change in WP correlated modestly with peak VO2 (r=−0.4, p<0.05).
Conclusions Patients with exertional dyspnea, normal BNP and normal cardiac filling pressures at rest may have markedly abnormal hemodynamic responses when assessed during exercise, suggesting that chronic symptoms are related to heart failure. Earlier and more accurate diagnosis using exercise hemodynamics may allow more appropriate targeting of interventions to treat and prevent HFpEF progression.