Pulmonary Vascular Resistance During Exercise Predicts Long-Term Outcomes in Heart Failure With Preserved Ejection Fraction
Oliveira, Rudolf Krawczenko Feitoza de [UNIFESP]
Systrom, David M.
Waxman, Aaron B.
Is part ofJournal Of Cardiac Failure
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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 restand exercise HFpEF (eHFpEFn = 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.
CitationJournal Of Cardiac Failure. Philadelphia, v. 24, n. 3, p. 169-176, 2018.
KeywordsHeart failure with preserved ejection fraction
pulmonary vascular dysfunction
heart failure hospitalization
SponsorshipNational Natural Science Foundation of China
Natural Science Foundation of Chongqing
Sao Paulo Research Foundation (FAPESP)
Brazilian National Council for Scientific and Technological Development (CNPq)
National Institutes of Health (NIH)
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