Exercise haemodynamics in heart failure with preserved ejection fraction: a systematic review and meta‐analysis
Abstract Aims Exercise right heart catheterization (RHC) is considered the gold‐standard test to diagnose heart failure with preserved ejection fraction (HFpEF). However, exercise RHC is an insufficiently standardized technique, and current haemodynamic thresholds to define HFpEF are not universally...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-10-01
|
| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13979 |
| _version_ | 1797794309274075136 |
|---|---|
| author | Claudia Baratto Sergio Caravita Davide Soranna Céline Dewachter Antoine Bondue Antonella Zambon Luigi P. Badano Gianfranco Parati Jean‐Luc Vachiéry |
| author_facet | Claudia Baratto Sergio Caravita Davide Soranna Céline Dewachter Antoine Bondue Antonella Zambon Luigi P. Badano Gianfranco Parati Jean‐Luc Vachiéry |
| author_sort | Claudia Baratto |
| collection | DOAJ |
| description | Abstract Aims Exercise right heart catheterization (RHC) is considered the gold‐standard test to diagnose heart failure with preserved ejection fraction (HFpEF). However, exercise RHC is an insufficiently standardized technique, and current haemodynamic thresholds to define HFpEF are not universally accepted. We sought to describe the exercise haemodynamics profile of HFpEF cohorts reported in literature, as compared with control subjects. Methods and results We performed a systematic literature review until December 2020. Studies reporting pulmonary artery wedge pressure (PAWP) at rest and peak exercise were extracted. Summary estimates of all haemodynamic variables were evaluated, stratified according to body position (supine/upright exercise). The PAWP/cardiac output (CO) slope during exercise was extrapolated. Twenty‐seven studies were identified, providing data for 2180 HFpEF patients and 682 controls. At peak exercise, patients with HFpEF achieved higher PAWP (30 [29–31] vs. 16 [15–17] mmHg, P < 0.001) and mean right atrial pressure (P < 0.001) than controls. These differences persisted after adjustment for age, sex, body mass index, and body position. However, peak PAWP values were highly heterogeneous among the cohorts (I2 = 93%), with a relative overlap with controls. PAWP/CO slope was steeper in HFpEF than in controls (3.75 [3.20–4.28] vs. 0.95 [0.30–1.59] mmHg/L/min, P value < 0.0001), even after adjustment for covariates (P = 0.007). Conclusions Despite methodological heterogeneity, as well as heterogeneity of pooled haemodynamic estimates, the exercise haemodynamic profile of HFpEF patients is consistent across studies and characterized by a steep PAWP rise during exercise. More standardization of exercise haemodynamics may be advisable for a wider application in clinical practice. |
| first_indexed | 2024-03-13T03:00:51Z |
| format | Article |
| id | doaj.art-aa96e3c78db047b8a9f8d0ad09d8485a |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-13T03:00:51Z |
| publishDate | 2022-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-aa96e3c78db047b8a9f8d0ad09d8485a2023-06-27T14:49:57ZengWileyESC Heart Failure2055-58222022-10-01953079309110.1002/ehf2.13979Exercise haemodynamics in heart failure with preserved ejection fraction: a systematic review and meta‐analysisClaudia Baratto0Sergio Caravita1Davide Soranna2Céline Dewachter3Antoine Bondue4Antonella Zambon5Luigi P. Badano6Gianfranco Parati7Jean‐Luc Vachiéry8Department of Cardiovascular, Neural and Metabolic Sciences Istituto Auxologico Italiano IRCCS, Ospedale San Luca Milan ItalyDepartment of Cardiovascular, Neural and Metabolic Sciences Istituto Auxologico Italiano IRCCS, Ospedale San Luca Milan ItalyBiostatistics Unit IRCCS Istituto Auxologico Italiano Milan ItalyDepartment of Cardiology Hopital Universitaire de Bruxelles, Hôpital Académique Erasme 808 Route de Lennik 1070 Bruxelles BelgiumDepartment of Cardiology Hopital Universitaire de Bruxelles, Hôpital Académique Erasme 808 Route de Lennik 1070 Bruxelles BelgiumBiostatistics Unit IRCCS Istituto Auxologico Italiano Milan ItalyDepartment of Cardiovascular, Neural and Metabolic Sciences Istituto Auxologico Italiano IRCCS, Ospedale San Luca Milan ItalyDepartment of Cardiovascular, Neural and Metabolic Sciences Istituto Auxologico Italiano IRCCS, Ospedale San Luca Milan ItalyDepartment of Cardiology Hopital Universitaire de Bruxelles, Hôpital Académique Erasme 808 Route de Lennik 1070 Bruxelles BelgiumAbstract Aims Exercise right heart catheterization (RHC) is considered the gold‐standard test to diagnose heart failure with preserved ejection fraction (HFpEF). However, exercise RHC is an insufficiently standardized technique, and current haemodynamic thresholds to define HFpEF are not universally accepted. We sought to describe the exercise haemodynamics profile of HFpEF cohorts reported in literature, as compared with control subjects. Methods and results We performed a systematic literature review until December 2020. Studies reporting pulmonary artery wedge pressure (PAWP) at rest and peak exercise were extracted. Summary estimates of all haemodynamic variables were evaluated, stratified according to body position (supine/upright exercise). The PAWP/cardiac output (CO) slope during exercise was extrapolated. Twenty‐seven studies were identified, providing data for 2180 HFpEF patients and 682 controls. At peak exercise, patients with HFpEF achieved higher PAWP (30 [29–31] vs. 16 [15–17] mmHg, P < 0.001) and mean right atrial pressure (P < 0.001) than controls. These differences persisted after adjustment for age, sex, body mass index, and body position. However, peak PAWP values were highly heterogeneous among the cohorts (I2 = 93%), with a relative overlap with controls. PAWP/CO slope was steeper in HFpEF than in controls (3.75 [3.20–4.28] vs. 0.95 [0.30–1.59] mmHg/L/min, P value < 0.0001), even after adjustment for covariates (P = 0.007). Conclusions Despite methodological heterogeneity, as well as heterogeneity of pooled haemodynamic estimates, the exercise haemodynamic profile of HFpEF patients is consistent across studies and characterized by a steep PAWP rise during exercise. More standardization of exercise haemodynamics may be advisable for a wider application in clinical practice.https://doi.org/10.1002/ehf2.13979Heart failureCardiac catheterizationHaemodynamicsExercise testingMeta‐analysis |
| spellingShingle | Claudia Baratto Sergio Caravita Davide Soranna Céline Dewachter Antoine Bondue Antonella Zambon Luigi P. Badano Gianfranco Parati Jean‐Luc Vachiéry Exercise haemodynamics in heart failure with preserved ejection fraction: a systematic review and meta‐analysis ESC Heart Failure Heart failure Cardiac catheterization Haemodynamics Exercise testing Meta‐analysis |
| title | Exercise haemodynamics in heart failure with preserved ejection fraction: a systematic review and meta‐analysis |
| title_full | Exercise haemodynamics in heart failure with preserved ejection fraction: a systematic review and meta‐analysis |
| title_fullStr | Exercise haemodynamics in heart failure with preserved ejection fraction: a systematic review and meta‐analysis |
| title_full_unstemmed | Exercise haemodynamics in heart failure with preserved ejection fraction: a systematic review and meta‐analysis |
| title_short | Exercise haemodynamics in heart failure with preserved ejection fraction: a systematic review and meta‐analysis |
| title_sort | exercise haemodynamics in heart failure with preserved ejection fraction a systematic review and meta analysis |
| topic | Heart failure Cardiac catheterization Haemodynamics Exercise testing Meta‐analysis |
| url | https://doi.org/10.1002/ehf2.13979 |
| work_keys_str_mv | AT claudiabaratto exercisehaemodynamicsinheartfailurewithpreservedejectionfractionasystematicreviewandmetaanalysis AT sergiocaravita exercisehaemodynamicsinheartfailurewithpreservedejectionfractionasystematicreviewandmetaanalysis AT davidesoranna exercisehaemodynamicsinheartfailurewithpreservedejectionfractionasystematicreviewandmetaanalysis AT celinedewachter exercisehaemodynamicsinheartfailurewithpreservedejectionfractionasystematicreviewandmetaanalysis AT antoinebondue exercisehaemodynamicsinheartfailurewithpreservedejectionfractionasystematicreviewandmetaanalysis AT antonellazambon exercisehaemodynamicsinheartfailurewithpreservedejectionfractionasystematicreviewandmetaanalysis AT luigipbadano exercisehaemodynamicsinheartfailurewithpreservedejectionfractionasystematicreviewandmetaanalysis AT gianfrancoparati exercisehaemodynamicsinheartfailurewithpreservedejectionfractionasystematicreviewandmetaanalysis AT jeanlucvachiery exercisehaemodynamicsinheartfailurewithpreservedejectionfractionasystematicreviewandmetaanalysis |