Clinical Significance of Exercise Pulmonary Hypertension With a Negative Diastolic Stress Test for Suspected Heart Failure With Preserved Ejection Fraction
Background Half of patients with heart failure with preserved ejection fraction (HFpEF) remain undiagnosed by resting evaluation alone. Therefore, exercise testing is proposed. The diastolic stress test (DST), however, has limited sensitivity. We aimed to determine the clinical significance of addin...
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Wiley
2024-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.032228 |
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| author | Jan Verwerft Jan Stassen Maarten Falter Youri Bekhuis Sarah Hoedemakers Tin Gojevic Sara Moura Ferreira Simon Vanhentenrijk Sarah Stroobants Siddharth Jogani Dominique Hansen Ruta Jasaityte Bernard Cosyns Alexander Van De Bruaene Philippe B. Bertrand Rudolf A. de Boer Andreas B. Gevaert Frederik H. Verbrugge Lieven Herbots Guido Claessen |
| author_facet | Jan Verwerft Jan Stassen Maarten Falter Youri Bekhuis Sarah Hoedemakers Tin Gojevic Sara Moura Ferreira Simon Vanhentenrijk Sarah Stroobants Siddharth Jogani Dominique Hansen Ruta Jasaityte Bernard Cosyns Alexander Van De Bruaene Philippe B. Bertrand Rudolf A. de Boer Andreas B. Gevaert Frederik H. Verbrugge Lieven Herbots Guido Claessen |
| author_sort | Jan Verwerft |
| collection | DOAJ |
| description | Background Half of patients with heart failure with preserved ejection fraction (HFpEF) remain undiagnosed by resting evaluation alone. Therefore, exercise testing is proposed. The diastolic stress test (DST), however, has limited sensitivity. We aimed to determine the clinical significance of adding the mean pulmonary artery pressure over cardiac output (mPAP/CO) slope to the DST in suspected HFpEF. Methods and Results In this prospective cohort study, consecutive patients (n=1936) with suspected HFpEF underwent exercise echocardiography with simultaneous respiratory gas analysis. These patients were stratified by exercise E over e′ (exE/e′) and mPAP/CO slope, and peak oxygen uptake, natriuretic peptides (NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide]), and score‐based HFpEF likelihood were compared. Twenty‐two percent of patients (n=428) had exE/e′<15 despite a mPAP/CO slope>3 mm Hg/L per min, 24% (n=464) had a positive DST (exE/e′≥15), and 54% (n=1044) had a normal DST and slope. Percentage of predicted oxygen uptake was similar in the group with exE/e′<15 but high mPAP/CO slope and the positive DST group (−2% [−5% to +1%]), yet worse than in those with normal DST and slope (−12% [−14% to −9%]). Patients with exE/e′<15 but a high slope had NT‐proBNP levels and H2FPEF (heavy, hypertensive, atrial fibrillation, pulmonary hypertension, elder; filling pressure) scores intermediate to the positive DST group and the group with both a normal DST and slope. Conclusions Twenty‐two percent of patients with suspected HFpEF presented with a mPAP/CO slope>3 mm Hg/L per min despite a negative DST. These patients had HFpEF characteristics and a peak oxygen uptake as low as patients with a positive DST. Therefore, an elevated mPAP/CO slope might indicate HFpEF irrespective of the DST result. |
| format | Article |
| id | doaj-art-1d13c3c29d1449e1a7e8cb12dec19fef |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-1d13c3c29d1449e1a7e8cb12dec19fef2025-08-20T02:27:46ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-08-01131510.1161/JAHA.123.032228Clinical Significance of Exercise Pulmonary Hypertension With a Negative Diastolic Stress Test for Suspected Heart Failure With Preserved Ejection FractionJan Verwerft0Jan Stassen1Maarten Falter2Youri Bekhuis3Sarah Hoedemakers4Tin Gojevic5Sara Moura Ferreira6Simon Vanhentenrijk7Sarah Stroobants8Siddharth Jogani9Dominique Hansen10Ruta Jasaityte11Bernard Cosyns12Alexander Van De Bruaene13Philippe B. Bertrand14Rudolf A. de Boer15Andreas B. Gevaert16Frederik H. Verbrugge17Lieven Herbots18Guido Claessen19Department of Cardiology Jessa Hospital Hasselt BelgiumDepartment of Cardiology Jessa Hospital Hasselt BelgiumDepartment of Cardiology Jessa Hospital Hasselt BelgiumDepartment of Cardiology Jessa Hospital Hasselt BelgiumDepartment of Cardiology Jessa Hospital Hasselt BelgiumFaculty of Medicine and Pharmacy Vrije Universiteit Brussel Brussels BelgiumDepartment of Cardiology Jessa Hospital Hasselt BelgiumDepartment of Cardiology Jessa Hospital Hasselt BelgiumDepartment of Cardiology Jessa Hospital Hasselt BelgiumDepartment of Cardiology Jessa Hospital Hasselt BelgiumFaculty of Rehabilitation Sciences REVAL/BIOMED, Hasselt University Hasselt BelgiumDepartment of Cardiology Jessa Hospital Hasselt BelgiumCentre for Cardiovascular Diseases University Hospital Brussels Jette BelgiumDepartment of Cardiology Jessa Hospital Hasselt BelgiumFaculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt BelgiumDepartment of Cardiology Erasmus MC Rotterdam The NetherlandsResearch Group Cardiovascular Diseases, GENCOR Department University of Antwerp BelgiumCentre for Cardiovascular Diseases University Hospital Brussels Jette BelgiumDepartment of Cardiology Jessa Hospital Hasselt BelgiumDepartment of Cardiology Jessa Hospital Hasselt BelgiumBackground Half of patients with heart failure with preserved ejection fraction (HFpEF) remain undiagnosed by resting evaluation alone. Therefore, exercise testing is proposed. The diastolic stress test (DST), however, has limited sensitivity. We aimed to determine the clinical significance of adding the mean pulmonary artery pressure over cardiac output (mPAP/CO) slope to the DST in suspected HFpEF. Methods and Results In this prospective cohort study, consecutive patients (n=1936) with suspected HFpEF underwent exercise echocardiography with simultaneous respiratory gas analysis. These patients were stratified by exercise E over e′ (exE/e′) and mPAP/CO slope, and peak oxygen uptake, natriuretic peptides (NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide]), and score‐based HFpEF likelihood were compared. Twenty‐two percent of patients (n=428) had exE/e′<15 despite a mPAP/CO slope>3 mm Hg/L per min, 24% (n=464) had a positive DST (exE/e′≥15), and 54% (n=1044) had a normal DST and slope. Percentage of predicted oxygen uptake was similar in the group with exE/e′<15 but high mPAP/CO slope and the positive DST group (−2% [−5% to +1%]), yet worse than in those with normal DST and slope (−12% [−14% to −9%]). Patients with exE/e′<15 but a high slope had NT‐proBNP levels and H2FPEF (heavy, hypertensive, atrial fibrillation, pulmonary hypertension, elder; filling pressure) scores intermediate to the positive DST group and the group with both a normal DST and slope. Conclusions Twenty‐two percent of patients with suspected HFpEF presented with a mPAP/CO slope>3 mm Hg/L per min despite a negative DST. These patients had HFpEF characteristics and a peak oxygen uptake as low as patients with a positive DST. Therefore, an elevated mPAP/CO slope might indicate HFpEF irrespective of the DST result.https://www.ahajournals.org/doi/10.1161/JAHA.123.032228diastolic heart failuredyspneaexercise testingHFpEFpulmonary hypertensionstress echocardiography |
| spellingShingle | Jan Verwerft Jan Stassen Maarten Falter Youri Bekhuis Sarah Hoedemakers Tin Gojevic Sara Moura Ferreira Simon Vanhentenrijk Sarah Stroobants Siddharth Jogani Dominique Hansen Ruta Jasaityte Bernard Cosyns Alexander Van De Bruaene Philippe B. Bertrand Rudolf A. de Boer Andreas B. Gevaert Frederik H. Verbrugge Lieven Herbots Guido Claessen Clinical Significance of Exercise Pulmonary Hypertension With a Negative Diastolic Stress Test for Suspected Heart Failure With Preserved Ejection Fraction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease diastolic heart failure dyspnea exercise testing HFpEF pulmonary hypertension stress echocardiography |
| title | Clinical Significance of Exercise Pulmonary Hypertension With a Negative Diastolic Stress Test for Suspected Heart Failure With Preserved Ejection Fraction |
| title_full | Clinical Significance of Exercise Pulmonary Hypertension With a Negative Diastolic Stress Test for Suspected Heart Failure With Preserved Ejection Fraction |
| title_fullStr | Clinical Significance of Exercise Pulmonary Hypertension With a Negative Diastolic Stress Test for Suspected Heart Failure With Preserved Ejection Fraction |
| title_full_unstemmed | Clinical Significance of Exercise Pulmonary Hypertension With a Negative Diastolic Stress Test for Suspected Heart Failure With Preserved Ejection Fraction |
| title_short | Clinical Significance of Exercise Pulmonary Hypertension With a Negative Diastolic Stress Test for Suspected Heart Failure With Preserved Ejection Fraction |
| title_sort | clinical significance of exercise pulmonary hypertension with a negative diastolic stress test for suspected heart failure with preserved ejection fraction |
| topic | diastolic heart failure dyspnea exercise testing HFpEF pulmonary hypertension stress echocardiography |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.032228 |
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