Exercise-induced pulmonary hypertension in HFpEF and HFrEF: Different pathophysiologic mechanism behind similar functional impairment

• Published in: Vascular pharmacology 2022-06, Vol.144, p.106978-106978, Article 106978
• Main Authors: Pugliese, Nicola Riccardo, Mazzola, Matteo, Madonna, Rosalinda, Gargani, Luna, De Biase, Nicolò, Dini, Frank L., Taddei, Stefano, De Caterina, Raffale, Masi, Stefano
• Format: Article
• Language: English
• Subjects: Atria; Bicycles; Blood pressure; Body mass; Body mass index; Body size; C-reactive protein; Carbon dioxide; Carbon monoxide; Cardiac output; Cardiopulmonary exercise test; Congestive heart failure; Echocardiography; Exercise-induced pulmonary hypertension; Heart failure; Heart failure with preserved ejection fraction; Hypertension; Impairment; Metabolic disorders; Metabolic syndrome; Oxygen consumption; Pulmonary arteries; Pulmonary artery; Pulmonary hypertension; Sex; Uric acid; Veins & arteries; Ventricle
• ISSN: 1537-1891; 1879-3649
• DOI: 10.1016/j.vph.2022.106978

Pathophysiological mechanisms behind cardio-pulmonary impairment in heart failure (HF) with reduced (HFrEF) and preserved (HFpEF) ejection fraction are likely different. We analysed them using combined cardiopulmonary-exercise stress echocardiography (CPET-ESE). We matched 1:1 subjects with HFrEF (n = 90) and HFpEF (n = 90) for age, sex, body mass index (BMI), peak oxygen consumption, and minute ventilation/carbon dioxide production slope. All patients underwent a symptom-limited graded ramp bicycle CPET-ESE compared with 40 age-, sex- and BMI-matched healthy controls. During a median follow-up of 25 months, we observed 22 deaths and 80 HF hospitalisations, with similar distribution between HFpEF and HFrEF. Compared with HFrEF, HFpEF had a higher prevalence of metabolic syndrome (p = 0.02) with higher levels of high-sensitivity C-reactive protein and uric acid (p