Heart failure & cardiomyopathies
Discrepancy in the Diagnosis of Heart Failure With Preserved Ejection Fraction Between Supine Versus Upright Exercise Hemodynamic Testing
Authors' conclusion
Half of patients who met HFpEF criteria in the supine position did not meet the criteria in the upright position. Patients with a discordant HFpEF phenotype had less structural and hemodynamic abnormalities compared with those with concordant HFpEF.
Study context
- Population
- Patients referred for exercise right heart catheterization for heart failure with preserved ejection fraction (HFpEF)met supine HFpEF criteria
- Participants
- 36 patients
- Exposure
- Discordant HFpEF vs concordant HFpEF
- Discordant HFpEFn = 18
- Outcome
- Discordance in HFpEF diagnosis between supine and upright exercise testing
Methodological details2-center, Supright protocol: submaximal supine bicycle ergometry (20 W) then maximal upright bicycle ergometry with breath-by-breath oxygen analyzer; position-specific HFpEF hemodynamic criteria
- 2-center
- Supright protocol: submaximal supine bicycle ergometry (20 W) then maximal upright bicycle ergometry with breath-by-breath oxygen analyzer; position-specific HFpEF hemodynamic criteria
Main finding
As reported in the abstract
Did not meet HFpEF criteria upright (of those meeting supine criteria)
Discordant HFpEF
50%
18
Observational data: associations, not effects.
Further findings
AF
- Less AF in discordant vs concordant HFpEF: 0% vs 55%
- P < 0.001
Left atrial volume
- Lower left atrial volume in discordant vs concordant HFpEF: 60±14 vs 77±21 mL
- P = 0.010
H2FPEF score
- Lower H2FPEF score in discordant vs concordant HFpEF: 2.1±1.3 vs 5.1±2.3
- P < 0.001
PCWP at rest, supine
- Supine PCWP at rest lower in discordant HFpEF: 15±4 vs 19±7 mm Hg
- P = 0.040
PCWP at rest, upright
- Upright PCWP at rest lower in discordant HFpEF: 8±4 vs 14±6 mm Hg
- P = 0.002
PCWP at peak exercise, upright
- Upright PCWP at peak exercise lower in discordant HFpEF: 14±4 vs 27±7 mm Hg
- P < 0.001
PCWP/cardiac output slope
- PCWP/cardiac output slope lower in discordant HFpEF: 1.6±1.7 vs 3.6±2.9
- P < 0.001
Maximal workload
- Maximal workload similar between groups: 46±18 vs 49±24 W
- P = 0.59
Peak oxygen consumption
- Peak oxygen consumption similar between groups: 11.4±2.8 vs 12.9±3.4 mL/[kg·min]
- P = 0.15
Original publication
Discrepancy in the Diagnosis of Heart Failure With Preserved Ejection Fraction Between Supine Versus Upright Exercise Hemodynamic Testing. Circ Heart Fail. Published 8 November 2024. doi:10.
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