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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Hemodynamic determinants of the abnormal cardiopulmonary exercise response in heart failure with preserved left

Micha T Maeder1, Bruce R Thompson, Nay Htun

  • 1Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.

Journal of Cardiac Failure
|September 4, 2012
PubMed

Insights

Heart failure with preserved ejection fraction (HFPEF) patients show abnormal cardiopulmonary exercise testing (CPET) responses, including a steeper ventilation/carbon dioxide production slope and lower peak oxygen uptake. These changes are linked to increased left ventricular filling pressures during exercise.

Area of Science:

  • Cardiology
  • Exercise Physiology
  • Heart Failure Research

Background:

  • Cardiopulmonary exercise testing (CPET) response in heart failure with preserved left ventricular ejection fraction (HFPEF) is not fully understood.
  • HFPEF is a clinical syndrome characterized by symptoms of heart failure with normal left ventricular ejection fraction.

Purpose of the Study:

  • To describe the CPET response in patients with HFPEF.
  • To identify the invasive hemodynamic determinants of the CPET response in HFPEF.

Main Methods:

  • Ten HFPEF patients and eight asymptomatic controls underwent maximal symptom-limited CPET.
  • Invasive hemodynamic monitoring via right heart catheterization was performed at rest and during exercise.

Main Results:

  • HFPEF patients exhibited a steeper VE/VCO(2) slope (34.3 vs. 28.4, P=.02) and lower peak VO(2) (15.1 vs. 26.6 mL*kg(-1)*min(-1), P=.02) compared to controls.
  • Slower heart rate recovery (HRR-1) was observed in HFPEF patients (10 vs. 27 beats/min, P<.001).
  • Abnormal CPET parameters correlated with increased left ventricular filling pressures during exercise.

Conclusions:

  • HFPEF is associated with fundamental alterations in CPET profiles.
  • Elevated left ventricular filling pressures during exercise may contribute to the observed CPET abnormalities in HFPEF.
Abstract

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