Abstract 16896: Exercise Pulmonary Capillary Wedge Pressure Patterns in Patients With Normal Resting Left-sided Filling Pressures Predict Heart Failure Outcomes

• Published in: Circulation (New York, N.Y.) N.Y.), 2015-11, Vol.132 (Suppl_3 Suppl 3), p.A16896-A16896
• Main Authors: Eisman, Aaron S, Shah, Ravi V, Dhakal, Bishnu P, Meller, Stephanie M, Pappagianopoulos, Paul P, Dress, Ashley E, Malhotra, Rajeev, Weiner, Rory B, Baggish, Aaron L, Lewis, Gregory D
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.132.suppl_3.16896

IntroductionSerial measurements of pulmonary capillary wedge pressure (PCWP) during exercise testing may help to improve hemodynamic (HD) classification of heart failure with preserved ejection fraction (HFpEF). However, the physiologic and prognostic significance of exercise PCWP patterns is largely unknown.HypothesisAn elevated PCWP increment relative to cardiac output (CO) augmentation during exercise will independently predict exercise capacity and outcomes in patients with dyspnea on exertion and normal resting PCWP (DOE-nlrW).MethodsIn a single center cohort of 175 patients referred for cardiopulmonary exercise testing (CPET) with invasive HD monitoring (n = 33 normal controls, n = 32 HFpEF with resting PCWP ≥ 15, and n = 110 consecutive patients with DOE-nlrW and LVEF > 0.45) 1,929 PCWP-CO points during exercise were measured. Median follow-up was 3.2 years and events consisted of HF hospitalization, CV death, or future RHC with resting PCWP ≥ 15 mmHg.ResultsPCWP-CO slope of 1.2±0.4 mmHg/L/min in controls was used to establish the upper limit (mean + 2SDev) of normal of 2mmHg/L/min. HFpEF patients had a PCWP-CO slope of 3.6±1.8 mmHg/L/min. In the DOE-nlrW cohort, patients achieved a mean peak VO2 of 17±6 ml/kg/min (74±19 % predicted), mean PCWP-CO was 2.1±1.3 mmHg/L/min (Figure) with 45 of 110 patients having elevated PCWP-CO. PCWP-CO but not resting PCWP was related to peak VO2 in univariable (rho = -0.51, p < 0.01) and multi-variable linear regression adjusted for age, sex, hypertension, beta blocker use, diabetes, and resting PCWP (ß = -0.17, p = 0.03). Increased PCWP-CO also predicted worse event-free survival in univariable Cox regression (HR 1.67, p < 0.01) and after adjustment for age, sex, BMI, and resting PCWP (HR 1.56, p = 0.03).ConclusionsElevated PCWP-CO during exercise ( > 2mmHg/L/min) is common in DOE-nlrW and predicts exercise capacity as well as outcomes, suggesting that assessment of exercise HD may help to refine early HFpEF diagnosis.