Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milano, Italy (C.B., S.C., A.F., G.B.P., L.P.B., G.P.).
Department of Medicine and Surgery (C.B., L.P.B., G.P.), University of Milano-Bicocca, Italy.
Circ Heart Fail. 2021 May;14(5):e007555. doi: 10.1161/CIRCHEARTFAILURE.120.007555. Epub 2021 May 6.
Exercise hemodynamics can differentiate heart failure with preserved ejection fraction (HFpEF) from noncardiac dyspnea. However, respiratory pressure swings may impact hemodynamic measurements, potentially leading to misdiagnosis of HFpEF. Moreover, threshold values for abnormal hemodynamic response indicative of HFpEF are not universally accepted. Thus, we sought to evaluate the impact of respiratory pressure swings on hemodynamic data interpretation as well as the concordance among 3 proposed exercise hemodynamic criteria for HFpEF: (1) end-expiratory pulmonary artery wedge pressure (PAWP) ≥25 mm Hg; (2) PAWP/cardiac output slope >2 mm Hg/L per minute; and (3) respiratory-averaged (avg) mean pulmonary artery pressure >30 mm Hg, total pulmonary resistance >3 WU, PAWP ≥20 mm Hg.
Fifty-seven patients with unexplained dyspnea (70% women, 70±9 years) underwent exercise cardiac catheterization. The difference between end-expiratory and averaged hemodynamic values, as well as the concordance among the 3 hemodynamic definitions of HFpEF, were assessed.
End-expiratory hemodynamics measurements were higher than values averaged across the respiratory cycle. During exercise, a larger proportion of patients exceeded the threshold of 25 mm Hg for PAWP rather than for PAWP (70% versus 53%, <0.01). The concordance of 3/3 HFpEF exercise hemodynamic criteria was recorded in 70% of patients. PAWP/cardiac output slope identified HFpEF more frequently than the other 2 criteria (81% versus 64% to 69%), incorporating over 97% of abnormal responses to the latter. Patients with 3/3 positive criteria had worse clinical, gas-exchange, and hemodynamic profiles.
Respiratory pressure swings impact on the exercise hemodynamic definitions of HFpEF that provide discordant results in 30% of patients. Equivocal diagnoses of HFpEF might be limited by adopting the most sensitive and inclusive criterion alone (ie, PAWP/cardiac output slope).
运动血液动力学可将射血分数保留的心力衰竭（HFpEF）与非心源性呼吸困难区分开来。然而，呼吸压力波动可能会影响血液动力学测量，从而导致 HFpEF 的误诊。此外，HFpEF 异常血液动力学反应的阈值值尚未被普遍接受。因此，我们试图评估呼吸压力波动对血液动力学数据解释的影响，以及 3 种拟议的 HFpEF 运动血液动力学标准之间的一致性：（1）呼气末肺动脉楔压（PAWP）≥25mmHg；（2）PAWP/心输出量斜率>2mmHg/L/分钟；（3）呼吸平均（avg）平均肺动脉压>30mmHg，总肺阻力>3WU，PAWP≥20mmHg。
57 例原因不明呼吸困难患者（70%女性，70±9 岁）接受运动心导管检查。评估了呼气末和平均血液动力学值之间的差异，以及 3 种 HFpEF 血液动力学定义的一致性。
呼气末血液动力学测量值高于呼吸周期内的平均值。在运动过程中，超过 25mmHg 的 PAWP 阈值的患者比例高于超过 PAWP 的患者比例（70%比 53%，<0.01）。3/3 HFpEF 运动血液动力学标准的一致性在 70%的患者中记录。PAWP/心输出量斜率比其他 2 个标准（81%比 64%至 69%）更频繁地识别出 HFpEF，纳入了超过 97%的对后者的异常反应。具有 3/3 阳性标准的患者的临床、气体交换和血液动力学特征更差。
呼吸压力波动影响 HFpEF 的运动血液动力学定义，在 30%的患者中提供不一致的结果。单独采用最敏感和最具包容性的标准（即 PAWP/心输出量斜率）可能会限制 HFpEF 的不确定诊断。
