Role of Diastolic Stress Testing in the Evaluation for Heart Failure With Preserved Ejection Fraction: A Simultaneous Invasive-Echocardiographic Study

• Published in: Circulation (New York, N.Y.) N.Y.), 2017-02, Vol.135 (9), p.825-838
• Main Authors: Obokata, Masaru, Kane, Garvan C, Reddy, Yogesh N V, Olson, Thomas P, Melenovsky, Vojtech, Borlaug, Barry A
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Echocardiography; Exercise Test; Female; Heart Failure - diagnosis; Heart Failure - diagnostic imaging; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain - analysis; Peptide Fragments - analysis; Prospective Studies; Stroke Volume - physiology; Ventricular Function, Left - physiology
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.116.024822

BACKGROUND:Diagnosis of heart failure with preserved ejection fraction (HFpEF) is challenging and relies largely on demonstration of elevated cardiac filling pressures (pulmonary capillary wedge pressure). Current guidelines recommend use of natriuretic peptides (N-terminal pro-B type natriuretic peptide) and rest/exercise echocardiography (E/e′ ratio) to make this determination. Data to support this practice are conflicting. METHODS:Simultaneous echocardiographic-catheterization studies were prospectively conducted at rest and during exercise in subjects with invasively proven HFpEF (n=50) and participants with dyspnea but no identifiable cardiac pathology (n=24). RESULTS:N-Terminal pro-B type natriuretic peptide levels were below the level considered to exclude disease (≤125 pg/mL) in 18% of subjects with HFpEF. E/e′ ratio was correlated with directly measured pulmonary capillary wedge pressure at rest (r=0.63, P