TY - JOUR
T1 - Clinical Significance of Exercise Pulmonary Hypertension With a Negative Diastolic Stress Test for Suspected Heart Failure With Preserved Ejection Fraction
AU - Verwerft, Jan
AU - Stassen, Jan
AU - Falter, Maarten
AU - Bekhuis, Youri
AU - Hoedemakers, Sarah
AU - Gojevic, Tin
AU - Ferreira, Sara Moura
AU - Vanhentenrijk, Simon
AU - Stroobants, Sarah
AU - Jogani, Siddharth
AU - Hansen, Dominique
AU - Jasaityte, Ruta
AU - Cosyns, Bernard
AU - Van De Bruaene, Alexander
AU - Bertrand, Philippe B.
AU - de Boer, Rudolf A.
AU - Gevaert, Andreas B.
AU - Verbrugge, Frederik H.
AU - Herbots, Lieven
AU - Claessen, Guido
N1 - Publisher Copyright:
© 2024 The Author(s).
PY - 2024/8/6
Y1 - 2024/8/6
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85200827071&partnerID=8YFLogxK
U2 - 10.1161/jaha.123.032228
DO - 10.1161/jaha.123.032228
M3 - Article
C2 - 39028104
AN - SCOPUS:85200827071
SN - 2047-9980
VL - 13
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 15
M1 - e032228
ER -