Discrepancy in the Diagnosis of Heart Failure With Preserved Ejection Fraction Between Supine Versus Upright Exercise Hemodynamic Testing.

IF 7.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Heart Failure Pub Date : 2024-11-08 DOI:10.1161/CIRCHEARTFAILURE.124.012020

Marat Fudim, Veraprapas Kittipibul, Ashley Swavely, Anna Gray, Jeffrey Mikitka, Erin Young, Olivia Dobbin, Matthew Radzom, Jacqueline Fee, Jeroen Molinger, Brandy Patterson, Giovanni Battista Perego, Luigi P Badano, Gianfranco Parati, Jean-Luc Vachiéry, Michele Senni, Ettore Lanzarone, Fabio Previdi, Stefano Paleari, Claudia Baratto, Sergio Caravita

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Abstract

Background: Invasive exercise right heart catheterization is a gold standard in diagnosing heart failure with preserved ejection fraction (HFpEF). Body positions during the test influence hemodynamics. However, the discrepancy in HFpEF diagnosis between exercise testing in supine versus upright position is unknown.

Methods: We conducted a 2-center prospective study enrolling patients referred for exercise right heart catheterization for HFpEF. We performed a Supright protocol integrating submaximal supine bicycle ergometry (20 W) followed by maximal upright bicycle ergometry with a breath-by-breath oxygen analyzer. HFpEF hemodynamic criteria specific to testing positions were applied. Patients were considered to have concordant HFpEF if they met criteria in both positions or discordant HFpEF if they met criteria only in the supine position.

Results: Of 36 patients who met HFpEF criteria in supine position, 18 (50%) did not meet criteria in upright position (discordant HFpEF). Discordant HFpEF had less atrial fibrillation (0% versus 55%; P<0.001), lower left atrial volume (60±14 versus 77±21 mL; P=0.010), and lower H₂FPEF score (2.1±1.3 versus 5.1±2.3; P<0.001). In supine position, pulmonary arterial wedge pressure was lower in discordant HFpEF at rest (15±4 versus 19±7 mm Hg; P=0.040). In upright position, pulmonary arterial wedge pressure was lower in discordant HFpEF both at rest (8±4 versus 14±6 mm Hg; P=0.002) and at peak exercise (14±4 versus 27±7 mm Hg; P<0.001). Pulmonary arterial wedge pressure/cardiac output slope was lower in discordant HFpEF (1.6±1.7 versus 3.6±2.9; P<0.001). Maximal workload (46±18 versus 49±24 W; P=0.59) or peak oxygen consumption (11.4±2.8 versus 12.9±3.4 mL/[kg·min]; P=0.15) was similar between groups.

Conclusions: Half of patients who met HFpEF criteria in the supine position did not meet the criteria in the upright position. Patients with a discordant HFpEF phenotype had less structural and hemodynamic abnormalities compared with those with concordant HFpEF. A Supright exercise right heart catheterization approach is feasible and merits further investigation to determine the clinical implications of discordant exercise hemodynamic findings in supine and upright positions.

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仰卧位与直立位运动血流动力学测试对射血分数保留型心力衰竭诊断的差异。

背景：有创运动右心导管检查是诊断射血分数保留型心力衰竭（HFpEF）的金标准。测试时的体位会影响血液动力学。然而，仰卧位与直立位运动测试对 HFpEF 诊断的差异尚不清楚：我们在两个中心开展了一项前瞻性研究，招募了因高频心衰而转诊进行运动右心导管检查的患者。我们进行了一项 Supright 方案，该方案综合了亚最大仰卧位自行车测力（20 W）和最大直立位自行车测力，并配有逐次呼吸氧气分析仪。我们采用了针对测试体位的 HFpEF 血液动力学标准。如果患者在两种体位下均符合标准，则被认为患有并发 HFpEF；如果患者仅在仰卧位下符合标准，则被认为患有不并发 HFpEF：结果：在 36 名仰卧位符合高频血流频谱标准的患者中，18 名（50%）直立位不符合标准（不一致高频血流频谱）。不一致 HFpEF 的心房颤动较少（0% 对 55%；PP=0.010），H2FPEF 评分较低（2.1±1.3 对 5.1±2.3；PP=0.040）。直立位时，不一致的HFpEF患者在静息时（8±4 对 14±6 mm Hg；P=0.002）和运动峰值时（14±4 对 27±7 mm Hg；PPP=0.59）的肺动脉楔压均较低，而峰值耗氧量（11.4±2.8 对 12.9±3.4 mL/[kg-min]；P=0.15）在组间相似：结论：仰卧位符合高频低氧血症标准的患者有一半在直立位不符合标准。不一致的 HFpEF 表型患者的结构和血液动力学异常少于一致的 HFpEF 患者。直立运动右心导管检查方法是可行的，值得进一步研究，以确定仰卧位和直立位运动血流动力学结果不一致的临床意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Heart Failure 医学-心血管系统

CiteScore

12.90

自引率

3.10%

发文量

271

审稿时长

6-12 weeks

期刊介绍： Circulation: Heart Failure focuses on content related to heart failure, mechanical circulatory support, and heart transplant science and medicine. It considers studies conducted in humans or analyses of human data, as well as preclinical studies with direct clinical correlation or relevance. While primarily a clinical journal, it may publish novel basic and preclinical studies that significantly advance the field of heart failure.