Prevalence of occult HFpEF and age-specific efficacy of passive leg raise in pulmonary hypertension.

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation Pub Date : 2025-05-28 DOI:10.1016/j.healun.2025.04.020

Chiho Nakata, Ayumi Goda, Kaori Takeuchi, Shinsuke Takeuchi, Hanako Kikuchi, Takumi Inami, Kyoko Soejima, Takashi Kohno

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引用次数: 0

Abstract

Background: Occult heart failure with preserved ejection fraction (HFpEF), characterized by elevated pulmonary arterial wedge pressure during exercise (PAWP_exercise), has gained attention in the context of pulmonary hypertension (PH). This study aimed to evaluate the prevalence of occult HFpEF and assess the diagnostic efficacy of passive leg raise (PLR) in patients with confirmed or suspected PH.

Methods: A total of 619 patients with normal resting PAWP underwent symptom-limited exercise testing using a supine cycle ergometer in conjunction with right heart catheterization (RHC) for PH diagnosis and treatment assessment. Occult HFpEF was defined as PAWP_exercise ≥ 25 mmHg. Receiver operating characteristic curves were constructed, and the area under the curve (AUC) was calculated to evaluate the diagnostic utility of PAWP_PLR for identifying occult HFpEF.

Results: Among the 619 patients (median age: 61 years, 78% female; median PAWP at rest: 8 mmHg), 80 (13%) demonstrated occult HFpEF. The prevalence was 7%, 21%, and 16% in patients aged < 60 years, 60-69 years, and ≥ 70 years, respectively. PAWP_PLR was significantly elevated in the occult HFpEF group compared to the non-HFpEF group across all age categories. The AUC values for detecting occult HFpEF using PAWP_PLR were 0.75 for patients < 60 years, 0.78 for those aged 60-69 years, and 0.79 for those ≥ 70 years, with respective cut-off values of 14, 13, and 13 mmHg.

Conclusions: Occult HFpEF is prevalent among patients with PH. PAWP_PLR serves as a valuable, non-invasive tool, necessitating age-specific thresholds to enhance diagnostic accuracy.

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肺动脉高压患者隐匿性HFpEF患病率及被动抬腿治疗的年龄特异性疗效。

背景：以运动时肺动脉楔压升高（PAWPexercise）为特征的隐秘性心力衰竭伴射血分数保留（HFpEF）在肺动脉高压（PH）的背景下引起了人们的关注。本研究旨在评估隐匿性HFpEF的发病率，并评估被动抬高腿（PLR）在确诊或疑似PH患者中的诊断效果。方法：619例正常静息型pap患者采用仰卧循环测力仪联合右心导管（RHC）进行症状受限运动试验，以评估PH诊断和治疗。隐匿性HFpEF定义为PAWPexercise≥25 mmHg。构建患者工作特征曲线，计算曲线下面积（AUC），评价PAWPPLR对隐匿性HFpEF的诊断价值。结果：619例患者(中位年龄：61岁，女性78%；静息时paap中位数：8 mmHg)， 80例（13%）表现为隐匿性HFpEF。年龄< 60岁、60-69岁和≥70岁的患者患病率分别为7%、21%和16%。在所有年龄组中，隐匿性HFpEF组的PAWPPLR均显著高于非HFpEF组。使用PAWPPLR检测隐匿性HFpEF的AUC值对于< 60岁的患者为0.75，对于60-69岁的患者为0.78，对于≥70岁的患者为0.79，截止值分别为14、13和13 mmHg。结论：隐匿性HFpEF在ph患者中普遍存在。PAWPPLR是一种有价值的、无创的工具，需要年龄特异性阈值来提高诊断准确性。

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

Journal of Heart and Lung Transplantation 医学-呼吸系统

CiteScore

10.10

自引率

6.70%

发文量

1667

审稿时长

69 days

期刊介绍： The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.