Huang W, Oliveira RKF, Lei H, Systrom DM, Waxman AB
J Card Fail. 2018 Mar;24(3):169-176. doi: 10.1016/j.cardfail.2017.11.003. Epub
2017 Nov 24.
BACKGROUND: In heart failure with preserved ejection fraction (HFpEF), the
prognostic value of pulmonary vascular dysfunction (PV-dysfunction), identified
by elevated pulmonary vascular resistance (PVR) at peak exercise, is not
completely understood. We evaluated the long-term prognostic implications of
PV-dysfunction in HFpEF during exercise in consecutive patients undergoing
invasive cardiopulmonary exercise testing for unexplained dyspnea.
METHODS: Patients with HFpEF were classified into 2 main groups: resting HFpEF
(n = 104, 62% female, age 61 years) with a pulmonary arterial wedge pressure
(PAWP) >15 mmHg at rest; and exercise HFpEF (eHFpEF; n = 81) with a PAWP <15 mmHg
at rest, but >20 mmHg during exercise. The eHFpEF group was further subdivided
into eHFpEF + PV-dysfunction (peak PVR ≥80 dynes/s/cm-5; n = 55, 60% female, age
64) group and eHFpEF – PV-dysfunction (peak PVR <80 dynes/s/cm-5; n = 26, 42%
female, age 54 years) group. Outcomes were analyzed for the first 9 years of
follow-up and included any cause mortality and heart failure (HF)-related
hospitalizations. The mean follow-up time was 6.7 ± 2.6 years (0.5-9.0).
RESULTS: Mortality rate did not differ among the groups. However, survival free
of HF-related hospitalization was lower for the eHFpEF + PV-dysfunction group
compared with eHFpEF – PV-dysfunction (P = .01). These findings were similar
between eHFpEF + PV-dysfunction and the resting HFpEF group (P = .774). By Cox
analysis, peak PVR ≥80 dynes/s/cm-5 was a predictor of HF-related hospitalization
for eHFpEF (hazard ratio 5.73, 95% confidence interval 1.05-31.22, P = .01). In
conclusion, the present study provides insight into the impact of PV-dysfunction
on outcomes of patients with exercise-induced HFpEF. An elevated peak PVR is
associated with a high risk of HF-related hospitalization.