Clinical Significance of Exercise Pulmonary Hypertension With a Negative Diastolic Stress Test for Suspected Heart Failure With Preserved Ejection Fraction

Author:

Verwerft Jan12ORCID,Stassen Jan12ORCID,Falter Maarten12ORCID,Bekhuis Youri12345ORCID,Hoedemakers Sarah1234ORCID,Gojevic Tin4,Ferreira Sara Moura12ORCID,Vanhentenrijk Simon134ORCID,Stroobants Sarah12ORCID,Jogani Siddharth12,Hansen Dominique6ORCID,Jasaityte Ruta12ORCID,Cosyns Bernard34ORCID,Van De Bruaene Alexander17ORCID,Bertrand Philippe B.25ORCID,de Boer Rudolf A.8ORCID,Gevaert Andreas B.910ORCID,Verbrugge Frederik H.34ORCID,Herbots Lieven12ORCID,Claessen Guido127611

Affiliation:

1. Department of Cardiology Jessa Hospital Hasselt Belgium

2. Faculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt Belgium

3. Centre for Cardiovascular Diseases University Hospital Brussels Jette Belgium

4. Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Brussels Belgium

5. Department of Cardiology Ziekenhuis‐Oost Limburg Genk Belgium

6. Faculty of Rehabilitation Sciences REVAL/BIOMED, Hasselt University Hasselt Belgium

7. Department of Cardiovascular Sciences KU Leuven Leuven Belgium

8. Department of Cardiology Erasmus MC Rotterdam The Netherlands

9. Research Group Cardiovascular Diseases, GENCOR Department University of Antwerp Belgium

10. Department of Cardiology Antwerp University Hospital (UZA) Edegem Belgium

11. Baker Heart and Diabetes Institute Melbourne Australia

Abstract

Background Half of patients with heart failure with preserved ejection fraction (HFpEF) remain undiagnosed by resting evaluation alone. Therefore, exercise testing is proposed. The diastolic stress test (DST), however, has limited sensitivity. We aimed to determine the clinical significance of adding the mean pulmonary artery pressure over cardiac output (mPAP/CO) slope to the DST in suspected HFpEF. Methods and Results In this prospective cohort study, consecutive patients (n=1936) with suspected HFpEF underwent exercise echocardiography with simultaneous respiratory gas analysis. These patients were stratified by exercise E over e ′ (exE/ e ′) and mPAP/CO slope, and peak oxygen uptake, natriuretic peptides (NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide]), and score‐based HFpEF likelihood were compared. Twenty‐two percent of patients (n=428) had exE/ e ′<15 despite a mPAP/CO slope>3 mm Hg/L per min, 24% (n=464) had a positive DST (exE/ e ′≥15), and 54% (n=1044) had a normal DST and slope. Percentage of predicted oxygen uptake was similar in the group with exE/ e ′<15 but high mPAP/CO slope and the positive DST group (−2% [−5% to +1%]), yet worse than in those with normal DST and slope (−12% [−14% to −9%]). Patients with exE/ e ′<15 but a high slope had NT‐proBNP levels and H 2 FPEF (heavy, hypertensive, atrial fibrillation, pulmonary hypertension, elder; filling pressure) scores intermediate to the positive DST group and the group with both a normal DST and slope. Conclusions Twenty‐two percent of patients with suspected HFpEF presented with a mPAP/CO slope>3 mm Hg/L per min despite a negative DST. These patients had HFpEF characteristics and a peak oxygen uptake as low as patients with a positive DST. Therefore, an elevated mPAP/CO slope might indicate HFpEF irrespective of the DST result.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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