Exertional Cardiac and Pulmonary Vascular Hemodynamics Among Patients with Heart Failure with Reduced Ejection Fraction.

Edward JA; Parker H; Stöhr EJ; McDonnell BJ; O’Gean K; Schulte M; Lawley JS; Cornwell WK 3rd;

Journal of cardiac failure [J Card Fail] 2023 Mar 03.
Date of Electronic Publication: 2023 Mar 03.

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.