Unexplained Exertional Dyspnea Caused by Low Ventricular Filling Pressures: Results from Clinical Invasive Cardiopulmonary Exercise Testing
Why the study?
Does inadequate ventricular filling related to low venous pressure cause exercise intolerance in patients with unexplained exertional dyspnea?
Population
619 consecutive patients undergoing clinically indicated invasive cardiopulmonary exercise tests for…
Comparison
Invasive cardiopulmonary exercise testing with… vs Patients with a normal exercise response…
Design
Cohort
Authors
Discussion
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Implication
Preload failure may explain exertional dyspnea; leaves open whether volume expansion improves outcomes in prospective trials.
Structured PICO
Does inadequate ventricular filling related to low venous pressure cause exercise intolerance in patients with unexplained exertional dyspnea?
P
Population
619 consecutive patients undergoing clinically indicated invasive cardiopulmonary exercise tests (iCPETs) for unexplained exertional dyspnea. Subgroups analyzed included 49 patients with impaired exercise capacity (low V̇o2max due to inadequate peak cardiac output, normal biventricular ejection fractions, and no pulmonary hypertension) and 28 patients with a normal exercise response.
I
Intervention
Invasive cardiopulmonary exercise testing (iCPET) with up to 2 L intravenous normal saline infusion prior to exercise to target an upright pulmonary capillary wedge pressure (PCWP) of ≥5 mmHg. A subset of 23 patients underwent a second iCPET after 2.0 ± 0.5 L saline infusion.
C
Comparator
Patients with a normal exercise response (n=28) undergoing the same iCPET protocol. For the subset analysis, patients served as their own controls (initial iCPET vs. second iCPET post-saline).
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Outcome
Hemodynamic and exercise capacity parameters at peak exercise, including right atrial pressure (RAP), pulmonary capillary wedge pressure (PCWP), and stroke volume (SV) augmentation.surrogate
Low ventricular filling pressures (preload failure) represent a distinct, clinically relevant etiology of unexplained exertional dyspnea that can be identified via invasive CPET and may respond to intravenous fluid administration.
Cite This Study
Oldham et al. (2016) studied this question.