Concomitant latent pulmonary vascular disease leads to impaired global cardiac performance in heart failure with preserved ejection fraction

Andreas Schuster*, Alexander Schulz, Torben Lange, Ruben Evertz, Finn Hartmann, Johannes T Kowallick, Kristian Hellenkamp, Martin Uecker, Tim Seidler, Gerd Hasenfuß, Sören J Backhaus

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: The REDUCE-LAP II trial demonstrated adverse outcomes after interatrial shunt device (IASD) placement in heart failure with preserved ejection fraction (HFpEF) attributed to latent pulmonary vascular disease (PVD). We hypothesized that exercise stress cardiovascular magnetic resonance (CMR) imaging could provide non-invasive characterization of cardiac and pulmonary physiology for improved patient selection. Methods and results: The HFpEF-Stress trial prospectively enrolled 75 patients with exertional dyspnoea and diastolic dysfunction. Patients underwent rest and exercise stress right heart catheterization, echocardiography and CMR imaging. Pulmonary artery and capillary wedge pressures, cardiac index (CI) and pulmonary vascular resistance (PVR) were calculated. Latent PVD was defined as increased PVR ≥ 1.74 Wood units during exercise stress. CMR assessed long-axis strains (LAS) and filling volumes of all cardiac chambers. Right ventricular (RV) function was further quantified by stroke and peak flow volumes. Patients with latent PVD (n = 24) showed lower RV function (rest tricuspid annular plane systolic excursion, p = 0.010; stress RV LAS, p < 0.001) compared to patients without (n = 43). During exercise stress, RV stroke and peak flow volumes (p < 0.001) were reduced and led to impaired left atrial filling (p = 0.040) with a strong statistical trend to impaired ventricular (LV) filling (p = 0.098). This subsequently resulted in reduced LV-CI (p < 0.001) despite preserved LV systolic function (LV LAS p ≥ 0.255). The degree of RV dysfunction during exercise stress best predicted latent PVD (RV peak flow, area under the curve at rest 0.73 vs. stress 0.89, p = 0.004). Conclusions: Latent PVD is a feature of HFpEF and is associated with impaired RV functional reserve, global diastolic filling and LV-CI. This can be quantified by CMR and used to identify patients likely to benefit from IASD implantation.

Original languageEnglish
Pages (from-to)322-331
Number of pages10
Journal European Journal of Heart Failure
Volume25
Issue number3
Early online date23 Jan 2023
DOIs
Publication statusPublished - Mar 2023

Keywords

  • cardiovascular magnetic resonance
  • exercise-stress
  • HFpEF
  • Cardiovascular magnetic resonance
  • Exercise stress

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fields of Expertise

  • Human- & Biotechnology

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