Haemodynamics, dyspnoea, and pulmonary reserve in heart failure with preserved ejection fraction

Masaru Obokata, Thomas P Olson, Yogesh N.V. Reddy, Vojtech Melenovsky, Garvan M Kane, Barry A Borlaug

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Aims Increases in left ventricular filling pressure are a fundamental haemodynamic abnormality in heart failure with preserved ejection fraction (HFpEF). However, very little is known regarding how elevated filling pressures cause pulmonary abnormalities or symptoms of dyspnoea. We sought to determine the relationships between simultaneously measured central haemodynamics, symptoms, and lung ventilatory and gas exchange abnormalities during exercise in HFpEF. Methods and results Subjects with invasively-proven HFpEF (n = 50) and non-cardiac causes of dyspnoea (controls, n = 24) underwent cardiac catheterization at rest and during exercise with simultaneous expired gas analysis. During submaximal (20 W) exercise, subjects with HFpEF displayed higher pulmonary capillary wedge pressures (PCWP) and pulmonary artery pressures, higher Borg perceived dyspnoea scores, and increased ventilatory drive and respiratory rate. At peak exercise, ventilation reserve was reduced in HFpEF compared with controls, with greater dead space ventilation (higher VD/VT). Increasing exercise PCWP was directly correlated with higher perceived dyspnoea scores, lower peak exercise capacity, greater ventilatory drive, worse New York Heart Association (NYHA) functional class, and impaired pulmonary ventilation reserve. Conclusion This study provides the first evidence linking altered exercise haemodynamics to pulmonary abnormalities and symptoms of dyspnoea in patients with HFpEF. Further study is required to identify the mechanisms by which haemodynamic derangements affect lung function and symptoms and to test novel therapies targeting exercise haemodynamics in HFpEF.

Original languageEnglish (US)
Pages (from-to)2810-2821
Number of pages12
JournalEuropean Heart Journal
Volume39
Issue number30
DOIs
StatePublished - Aug 1 2018

Fingerprint

Dyspnea
Heart Failure
Hemodynamics
Exercise
Lung
Pulmonary Wedge Pressure
Ventilation
Gases
Pressure
Exercise Therapy
Pulmonary Ventilation
Ventricular Pressure
Cardiac Catheterization
Respiratory Rate
Pulmonary Artery

Keywords

  • Dyspnoea
  • Exercise
  • Heart failure
  • Pulmonary function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Haemodynamics, dyspnoea, and pulmonary reserve in heart failure with preserved ejection fraction. / Obokata, Masaru; Olson, Thomas P; Reddy, Yogesh N.V.; Melenovsky, Vojtech; Kane, Garvan M; Borlaug, Barry A.

In: European Heart Journal, Vol. 39, No. 30, 01.08.2018, p. 2810-2821.

Research output: Contribution to journalArticle

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