Resting and exercise haemodynamic characteristics of patients with advanced heart failure and preserved ejection fraction

• DOI: 10.1002/ehf2.13697
• Publication Date: 2021-12-08T08:49:19Z
• Authors: T. Deis; E. Wolsk; J. Mujkanovic; J. Komtebedde; D. Burkhoff; D. Kaye; G. Hasenfuß; C. Hayward; J. Van der Heyden; M.C. Petrie; S.J. Shah; B.A. Borlaug; R. Kahwash; S. Litwin; E. Hoendermis; S. Hummel; F. Gustafsson
• Keywords: Heart Failure; OUTCOMES; Haemodynamics; REDUCE LAP-HF; Advanced heart failure; Hemodynamics; Stroke Volume; Invasive exercise testing; Original Articles; Cardiovascular Medicine; PRESSURE; Ventricular Function, Left; 3. Good health; 03 medical and health sciences; Heart failure with preserved ejection fraction; Atrial Pressure; 0302 clinical medicine; RC666-701; Health Sciences; Diseases of the circulatory (Cardiovascular) system; Humans; SHUNT DEVICE

AbstractAimsThis study aimed to describe haemodynamic features of patients with advanced heart failure with preserved ejection fraction (HFpEF) as defined by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).Methods and resultsWe used pooled data from two dedicated HFpEF studies with invasive exercise haemodynamic protocols, the REDUCE LAP‐HF (Reduce Elevated Left Atrial Pressure in Patients with Heart Failure) trial and the REDUCE LAP‐HF I trial, and categorized patients according to advanced heart failure (AdHF) criteria. The well‐characterized HFpEF patients were considered advanced if they had persistent New York Heart Association classification of III–IV and heart failure (HF) hospitalization < 12 months and a 6 min walk test distance < 300 m. Twenty‐four (22%) out of 108 patients met the AdHF criteria. On evaluation, clinical characteristics and resting haemodynamics were not different in the two groups. Patients with AdHF had lower work capacity compared with non‐advanced patients (35 ± 16 vs. 45 ± 18 W, P = 0.021). Workload‐corrected pulmonary capillary wedge pressure normalized to body weight (PCWL) was higher in AdHF patients compared with non‐advanced (112 ± 55 vs. 86 ± 49 mmHg/W/kg, P = 0.04). Further, AdHF patients had a smaller increase in cardiac index during exercise (1.1 ± 0.7 vs. 1.6 ± 0.9 L/min/m2, P = 0.028).ConclusionsA significantly higher PCWL and lower cardiac index reserve during exercise were observed in AdHF patients compared with non‐advanced. These differences were not apparent at rest. Therapies targeting the haemodynamic compromise associated with advanced HFpEF are needed.