The haemodynamic basis of lung congestion during exercise in heart failure with preserved ejection fraction
Authors
Discussion
Loading...
Member takes
Implication
Randomized trial reveals exercise-induced lung congestion in heart failure with preserved ejection fraction links to elevated capillary pressures, suggesting impaired venous clearance.
Key Points
- To determine the hemodynamic mechanisms responsible for the acute development of extravascular lung water during exercise in patients with heart failure and preserved ejection fraction.
- Interventional clinical trial (NCT02885636) evaluating 61 compensated, ambulatory patients with heart failure with preserved ejection fraction.
- Participants underwent invasive hemodynamic exercise testing with high-fidelity micromanometers alongside simultaneous lung ultrasound, echocardiography, and expired gas analysis at rest and during submaximal exercise.
- Patients were categorized based on the presence (HFpEFLW+, n=33) or absence (HFpEFLW-, n=28) of exercise-induced extravascular lung water using sonographic B-line artefacts.
- An increase in extravascular lung water during submaximal exercise occurred in 54% of patients (33 of 61).
- Resting right ventricular dysfunction was two-fold more common in HFpEFLW+ compared to HFpEFLW- patients (64% vs. 31%), accompanied by lower right ventricular systolic velocity and fractional area change.
- Exercise-induced lung congestion was significantly associated with elevated pulmonary capillary wedge pressure, higher right atrial pressure, and worse right ventricular-pulmonary artery coupling (AUC 0.76–0.84).
Cite This Study
Reddy et al. (2019) studied this question.