Heart failure & cardiomyopathies
Comprehensive Exploration of Unexplained Dyspnoea in Subjects with Normal Ejection Fraction and Low Natriuretic Peptides
Authors' conclusion
The most common causes of unexplained exertional dyspnoea in patients without significant elevation of natriuretic peptides are peripheral deconditioning, HFpEF and hyperventilation. Studying patients during exercise allows for getting more data about pathophysiology and improving patient phenotyping and management. Early unmasking of HFpEF using exercise echocardiography and/or CPX and initiation of treatment could prevent hospitalizations for acute heart failure. Although using exercise testing, many patients could not be classified according to their diagnosis, and this reinforces the need to better define exercise diagnostic criteria.
Study context
- Population
- Patients with exertional dyspnoea and normal/near-to-normal N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, without known significant heart disease, lung disease or renal insufficiency stage ≥ 4age 62 ± 7 years old, 85% women
- Participants
- 66 patients
- Comparison
- Patients with heart failure with preserved ejection fraction (HFpEF) compared with patients without HFpEF
- HFpEFn = 11
- Isolated deconditioningn = 31
- Idiopathic hyperventilationn = 5
- No objective cause of dyspnoean = 19
- Outcome
- Cause of dyspnoea
Main finding
As reported in the abstract
Further findings
Characteristics of HFpEF vs non-HFpEF patients
- HFpEF patients were older, more often hypertensive and diabetic, with higher NT-proBNP levels
- Higher E/e′ ratios during exercise echocardiography in HFpEF
- Lower VO2 peaks and steeper ventilation (VE)/VCO2 slopes during CPX in HFpEF
- Psychological impact on SF-36 less important in HFpEF patients than in other patients
Original publication
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