Department of Cardiology and Vascular Medicine, University Hospital Essen, University Duisburg-Essen, West German Heart and Vascular Center, Essen, Germany.
Medistat-Biomedical Statistics, Medistat GmbH, Krummwisch, Germany.
Eur J Heart Fail. 2023 Oct;25(10):1768-1780. doi: 10.1002/ejhf.2995. Epub 2023 Aug 24.
Pulmonary capillary wedge pressure (PAWP) ≥25 mmHg during bicycle ergometry is recommended to uncover occult heart failure with preserved ejection fraction. We hypothesized that PAWP increase would differ in available diastolic stress tests and that the margin of PAWP ≥25 mmHg would only be reliably achieved through ergometry.
We conducted a prospective, single-arm study in patients with an intermediate risk for heart failure with preserved ejection fraction according to the ESC HFA-PEFF score. A total of 19 patients underwent four stress test modalities in randomized order: leg raise, fluid challenge, handgrip, and bicycle ergometry. The primary outcome was the difference (Δ) between resting and exercise PAWP in each modality. Secondary outcomes were differences (Δ) in mean pulmonary artery pressure (mPAP), cardiac output (CO), as well as the ratios between mPAP and PAWP to CO. Compared to resting values, passive leg raise (Δ7.7 ± 8.0 mmHg, p = 0.030), fluid challenge (Δ9.2 ± 6.4 mmHg, p = 0.003), dynamic handgrip (Δ9.6 ± 7.5 mmHg, p = 0.002), and bicycle ergometry (Δ22.3 ± 5.0 mmHg, p < 0.001) uncovered increased PAWP during exercise. Amongst these, bicycle ergometry also demonstrated the highest ΔmPAP (27.2 ± 7.1 mmHg, p < 0.001), ΔCO (3.3 ± 2.6 L/min, p < 0.001), ΔmPAP/CO ratio (2.3 ± 2.0 mmHg/L/min, p < 0.001), and ΔPAWP/CO ratio (2.2 ± 1.4 mmHg/L/min, p < 0.001) compared to other modalities. PAWP ≥25 mmHg was only reliably achieved in bicycle ergometry (31.1 ± 3.9 mmHg). In all other modalities only 10.5% of patients achieved PAWP ≥25 mmHg (handgrip 18.4 ± 6.6 mmHg, fluid 18.1 ± 5.6 mmHg, leg raise 16.5 ± 7.0 mmHg).
We demonstrate that bicycle ergometry exhibits a distinct haemodynamic response with higher increase of PAWP compared to other modalities. This finding needs to be considered for valid detection of exercise PAWP ≥25 mmHg when non-bicycle tests remain inconclusive.
在踏车运动试验中，肺毛细血管楔压（PAWP）≥25mmHg 被推荐用于发现射血分数保留的心力衰竭的隐匿性心衰。我们假设在现有的舒张性压力测试中，PAWP 会有不同的增加，并且只有通过踏车运动才能可靠地达到 PAWP≥25mmHg 的边缘。
我们对 ESC HFA-PEFF 评分中间风险的射血分数保留的心力衰竭患者进行了一项前瞻性、单臂研究。共有 19 名患者以随机顺序接受了四种应激测试方式：腿部抬高、液体挑战、手握和踏车运动。主要结果是每种方式中静息和运动时 PAWP 的差异（Δ）。次要结果是平均肺动脉压（mPAP）、心输出量（CO）以及 mPAP 和 PAWP 与 CO 的比值的差异（Δ）。与静息值相比，被动腿部抬高（Δ7.7±8.0mmHg，p=0.030）、液体挑战（Δ9.2±6.4mmHg，p=0.003）、动态手握（Δ9.6±7.5mmHg，p=0.002）和踏车运动（Δ22.3±5.0mmHg，p<0.001）在运动中发现了升高的 PAWP。在这些方式中，踏车运动还显示出最高的ΔmPAP（27.2±7.1mmHg，p<0.001）、ΔCO（3.3±2.6L/min，p<0.001）、ΔmPAP/CO 比值（2.3±2.0mmHg/L/min，p<0.001）和ΔPAWP/CO 比值（2.2±1.4mmHg/L/min，p<0.001），与其他方式相比。PAWP≥25mmHg 仅在踏车运动中可靠地达到（31.1±3.9mmHg）。在所有其他方式中，只有 10.5%的患者达到了 PAWP≥25mmHg（手握 18.4±6.6mmHg，液体 18.1±5.6mmHg，腿部抬高 16.5±7.0mmHg）。
我们证明，与其他方式相比，踏车运动具有明显的血液动力学反应，PAWP 升高更为明显。当非踏车试验结果不确定时，这一发现需要考虑到有效检测运动时 PAWP≥25mmHg。
