Key result
Increased exercise PCWP linked to at least ~95% higher mortality across preserved and impaired LVEF.
Why the study?
Exercise stress testing can stratify mortality risk in specific heart failure populations but is not universally applied, prompting evaluation of invasive exercise testing in a real-world suspected heart failure cohort.
Does invasive exercise testing improve prediction of all-cause mortality in patients with symptomatic heart failure?
Cohort (n=682)
Does invasive exercise testing improve prediction of all-cause mortality in patients with symptomatic heart failure?
Effect estimate: HR 1.950 (preserved LVEF), HR 3.212 (impaired LVEF) (95% CI 1.12-3.34, 1.75-5.70)
p-value: p=0.018, <0.001
Invasive exercise testing with measurement of PCWL improves mortality prediction in symptomatic heart failure patients, demonstrating that a favorable exercise response indicates lower mortality risk independent of resting LVEF.
May refine HF mortality risk stratification by exercise PCWP response; hypothesis-generating, needs prospective validation before practice change.
Aims: Exercise stress testing can stratify specific populations of heart failure patients for mortality risk, but is not universally applied. The aim of the present study was to investigate the prognostic capabilities of invasive exercise testing in a real-world cohort of suspected heart failure patients in whom non-cardiac causes of dyspnea were excluded. Methods: We retrospectively analyzed the survival of 682 patients who underwent right heart catheterization at rest and during exercise between 2007 and 2017 for dyspnea and expected heart failure. Pulmonary capillary wedge pressure (PCWP) at rest and the PCWP response to exercise, expressed as the ratio of PCWP at peak exercise to workload normalized to body weight (PCWL (mmHg/W/kg)), were determined. Mortality data were retrieved from the official German death registry. Results: Over a median follow-up period of 8.5 years, PCWL is a stronger predictor of all-cause mortality than PCWP. Patients featuring a reduced left ventricular ejection fraction (LVEF; <50%), but favorable response to exercise (PCWL <34.7 mmHg/W/kg), have a similar mortality risk to patients with a normal LVEF and low PCWL (hazard ratio (HR) 1.180, 95% CI 0.48−2.91, p = 0.719). Irrespective of LVEF, an increased PCWL during exercise was associated with a significantly increased mortality (HR 1.950 with preserved LVEF, 95% CI 1.12−3.34, p = 0.018; and HR 3.212 with impaired LVEF, 95% CI 1.75−5.70, p < 0.001). Conclusions: In patients with clinical heart failure, invasive exercise testing improves the prediction of mortality. Subjects with a favorable response to exercise have a relatively low mortality irrespective of left ventricular systolic function.
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Ahlgrim et al. (2022) conducted a cohort in Symptomatic Heart Failure (n=682). Increased pulmonary capillary wedge pressure response to exercise (PCWL) vs. Low PCWL (<34.7 mmHg/W/kg) was evaluated on All-cause mortality (HR 1.950 (preserved LVEF), HR 3.212 (impaired LVEF), 95% CI 1.12-3.34, 1.75-5.70, p=0.018, <0.001). An increased pulmonary capillary wedge pressure response to exercise was associated with significantly increased mortality in patients with preserved (HR 1.95) and impaired LVEF (HR 3.21).
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