The haemodynamic basis of lung congestion during exercise in heart failure with preserved ejection fraction

Yogesh N.V. Reddy, Masaru Obokata, Brandon Wiley, Katlyn E. Koepp, Caitlin C. Jorgenson, Alexander Egbe, Vojtech Melenovsky, Rickey E. Carter, Barry A. Borlaug

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

AIMS : Increases in extravascular lung water (EVLW) during exercise contribute to symptoms, morbidity, and mortality in patients with heart failure and preserved ejection fraction (HFpEF), but the mechanisms leading to pulmonary congestion during exercise are not well-understood. METHODS AND RESULTS : Compensated, ambulatory patients with HFpEF (n = 61) underwent invasive haemodynamic exercise testing using high-fidelity micromanometers with simultaneous lung ultrasound, echocardiography, and expired gas analysis at rest and during submaximal exercise. The presence or absence of EVLW was determined by lung ultrasound to evaluate for sonographic B-line artefacts. An increase in EVLW during exercise was observed in 33 patients (HFpEFLW+, 54%), while 28 (46%) did not develop EVLW (HFpEFLW-). Resting left ventricular function was similar in the groups, but right ventricular (RV) dysfunction was two-fold more common in HFpEFLW+ (64 vs. 31%), with lower RV systolic velocity and RV fractional area change. As compared to HFpEFLW-, the HFpEFLW+ group displayed higher pulmonary capillary wedge pressure (PCWP), higher pulmonary artery (PA) pressures, worse RV-PA coupling, and higher right atrial (RA) pressures during exercise, with increased haemoconcentration indicating greater loss of water from the vascular space. The development of lung congestion during exercise was significantly associated with elevations in PCWP and RA pressure as well as impairments in RV-PA coupling (area under the curve values 0.76-0.84). CONCLUSION : Over half of stable outpatients with HFpEF develop increases in interstitial lung water, even during submaximal exercise. The acute development of lung congestion is correlated with increases in pulmonary capillary hydrostatic pressure that favours fluid filtration, and systemic venous hypertension due to altered RV-PA coupling, which may interfere with fluid clearance. CLINICAL TRIAL REGISTRATION : NCT02885636.

Original languageEnglish (US)
Pages (from-to)3721-3730
Number of pages10
JournalEuropean heart journal
Volume40
Issue number45
DOIs
StatePublished - Dec 1 2019

Fingerprint

Heart Failure
Hemodynamics
Extravascular Lung Water
Exercise
Lung
Pulmonary Artery
Pulmonary Wedge Pressure
Atrial Pressure
Right Ventricular Dysfunction
Hydrostatic Pressure
Water
Left Ventricular Function
Artifacts
Area Under Curve
Blood Vessels
Echocardiography
Outpatients
Gases
Clinical Trials
Hypertension

Keywords

  • Exercise haemodynamics
  • Heart failure
  • Heart failure with preserved ejection fraction
  • Pulmonary oedema

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The haemodynamic basis of lung congestion during exercise in heart failure with preserved ejection fraction. / Reddy, Yogesh N.V.; Obokata, Masaru; Wiley, Brandon; Koepp, Katlyn E.; Jorgenson, Caitlin C.; Egbe, Alexander; Melenovsky, Vojtech; Carter, Rickey E.; Borlaug, Barry A.

In: European heart journal, Vol. 40, No. 45, 01.12.2019, p. 3721-3730.

Research output: Contribution to journalArticle

Reddy, Yogesh N.V. ; Obokata, Masaru ; Wiley, Brandon ; Koepp, Katlyn E. ; Jorgenson, Caitlin C. ; Egbe, Alexander ; Melenovsky, Vojtech ; Carter, Rickey E. ; Borlaug, Barry A. / The haemodynamic basis of lung congestion during exercise in heart failure with preserved ejection fraction. In: European heart journal. 2019 ; Vol. 40, No. 45. pp. 3721-3730.
@article{9a04a002ed8c453c8295ab8acef9e382,
title = "The haemodynamic basis of lung congestion during exercise in heart failure with preserved ejection fraction",
abstract = "AIMS : Increases in extravascular lung water (EVLW) during exercise contribute to symptoms, morbidity, and mortality in patients with heart failure and preserved ejection fraction (HFpEF), but the mechanisms leading to pulmonary congestion during exercise are not well-understood. METHODS AND RESULTS : Compensated, ambulatory patients with HFpEF (n = 61) underwent invasive haemodynamic exercise testing using high-fidelity micromanometers with simultaneous lung ultrasound, echocardiography, and expired gas analysis at rest and during submaximal exercise. The presence or absence of EVLW was determined by lung ultrasound to evaluate for sonographic B-line artefacts. An increase in EVLW during exercise was observed in 33 patients (HFpEFLW+, 54{\%}), while 28 (46{\%}) did not develop EVLW (HFpEFLW-). Resting left ventricular function was similar in the groups, but right ventricular (RV) dysfunction was two-fold more common in HFpEFLW+ (64 vs. 31{\%}), with lower RV systolic velocity and RV fractional area change. As compared to HFpEFLW-, the HFpEFLW+ group displayed higher pulmonary capillary wedge pressure (PCWP), higher pulmonary artery (PA) pressures, worse RV-PA coupling, and higher right atrial (RA) pressures during exercise, with increased haemoconcentration indicating greater loss of water from the vascular space. The development of lung congestion during exercise was significantly associated with elevations in PCWP and RA pressure as well as impairments in RV-PA coupling (area under the curve values 0.76-0.84). CONCLUSION : Over half of stable outpatients with HFpEF develop increases in interstitial lung water, even during submaximal exercise. The acute development of lung congestion is correlated with increases in pulmonary capillary hydrostatic pressure that favours fluid filtration, and systemic venous hypertension due to altered RV-PA coupling, which may interfere with fluid clearance. CLINICAL TRIAL REGISTRATION : NCT02885636.",
keywords = "Exercise haemodynamics, Heart failure, Heart failure with preserved ejection fraction, Pulmonary oedema",
author = "Reddy, {Yogesh N.V.} and Masaru Obokata and Brandon Wiley and Koepp, {Katlyn E.} and Jorgenson, {Caitlin C.} and Alexander Egbe and Vojtech Melenovsky and Carter, {Rickey E.} and Borlaug, {Barry A.}",
year = "2019",
month = "12",
day = "1",
doi = "10.1093/eurheartj/ehz713",
language = "English (US)",
volume = "40",
pages = "3721--3730",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "45",

}

TY - JOUR

T1 - The haemodynamic basis of lung congestion during exercise in heart failure with preserved ejection fraction

AU - Reddy, Yogesh N.V.

AU - Obokata, Masaru

AU - Wiley, Brandon

AU - Koepp, Katlyn E.

AU - Jorgenson, Caitlin C.

AU - Egbe, Alexander

AU - Melenovsky, Vojtech

AU - Carter, Rickey E.

AU - Borlaug, Barry A.

PY - 2019/12/1

Y1 - 2019/12/1

N2 - AIMS : Increases in extravascular lung water (EVLW) during exercise contribute to symptoms, morbidity, and mortality in patients with heart failure and preserved ejection fraction (HFpEF), but the mechanisms leading to pulmonary congestion during exercise are not well-understood. METHODS AND RESULTS : Compensated, ambulatory patients with HFpEF (n = 61) underwent invasive haemodynamic exercise testing using high-fidelity micromanometers with simultaneous lung ultrasound, echocardiography, and expired gas analysis at rest and during submaximal exercise. The presence or absence of EVLW was determined by lung ultrasound to evaluate for sonographic B-line artefacts. An increase in EVLW during exercise was observed in 33 patients (HFpEFLW+, 54%), while 28 (46%) did not develop EVLW (HFpEFLW-). Resting left ventricular function was similar in the groups, but right ventricular (RV) dysfunction was two-fold more common in HFpEFLW+ (64 vs. 31%), with lower RV systolic velocity and RV fractional area change. As compared to HFpEFLW-, the HFpEFLW+ group displayed higher pulmonary capillary wedge pressure (PCWP), higher pulmonary artery (PA) pressures, worse RV-PA coupling, and higher right atrial (RA) pressures during exercise, with increased haemoconcentration indicating greater loss of water from the vascular space. The development of lung congestion during exercise was significantly associated with elevations in PCWP and RA pressure as well as impairments in RV-PA coupling (area under the curve values 0.76-0.84). CONCLUSION : Over half of stable outpatients with HFpEF develop increases in interstitial lung water, even during submaximal exercise. The acute development of lung congestion is correlated with increases in pulmonary capillary hydrostatic pressure that favours fluid filtration, and systemic venous hypertension due to altered RV-PA coupling, which may interfere with fluid clearance. CLINICAL TRIAL REGISTRATION : NCT02885636.

AB - AIMS : Increases in extravascular lung water (EVLW) during exercise contribute to symptoms, morbidity, and mortality in patients with heart failure and preserved ejection fraction (HFpEF), but the mechanisms leading to pulmonary congestion during exercise are not well-understood. METHODS AND RESULTS : Compensated, ambulatory patients with HFpEF (n = 61) underwent invasive haemodynamic exercise testing using high-fidelity micromanometers with simultaneous lung ultrasound, echocardiography, and expired gas analysis at rest and during submaximal exercise. The presence or absence of EVLW was determined by lung ultrasound to evaluate for sonographic B-line artefacts. An increase in EVLW during exercise was observed in 33 patients (HFpEFLW+, 54%), while 28 (46%) did not develop EVLW (HFpEFLW-). Resting left ventricular function was similar in the groups, but right ventricular (RV) dysfunction was two-fold more common in HFpEFLW+ (64 vs. 31%), with lower RV systolic velocity and RV fractional area change. As compared to HFpEFLW-, the HFpEFLW+ group displayed higher pulmonary capillary wedge pressure (PCWP), higher pulmonary artery (PA) pressures, worse RV-PA coupling, and higher right atrial (RA) pressures during exercise, with increased haemoconcentration indicating greater loss of water from the vascular space. The development of lung congestion during exercise was significantly associated with elevations in PCWP and RA pressure as well as impairments in RV-PA coupling (area under the curve values 0.76-0.84). CONCLUSION : Over half of stable outpatients with HFpEF develop increases in interstitial lung water, even during submaximal exercise. The acute development of lung congestion is correlated with increases in pulmonary capillary hydrostatic pressure that favours fluid filtration, and systemic venous hypertension due to altered RV-PA coupling, which may interfere with fluid clearance. CLINICAL TRIAL REGISTRATION : NCT02885636.

KW - Exercise haemodynamics

KW - Heart failure

KW - Heart failure with preserved ejection fraction

KW - Pulmonary oedema

UR - http://www.scopus.com/inward/record.url?scp=85075960533&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075960533&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehz713

DO - 10.1093/eurheartj/ehz713

M3 - Article

C2 - 31609443

AN - SCOPUS:85075960533

VL - 40

SP - 3721

EP - 3730

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 45

ER -