Exercise testing in heart failure with preserved ejection fraction: an appraisal through diagnosis, pathophysiology and therapy – A clinical consensus statement of the Heart Failure Association and European Association of Preventive Cardiology of the European Society of Cardiology DOI Creative Commons
Marco Guazzi, Matthias Wilhelm, Martin Halle

et al.

European Journal of Heart Failure, Journal Year: 2022, Volume and Issue: 24(8), P. 1327 - 1345

Published: July 1, 2022

Patients with heart failure preserved ejection fraction (HFpEF) universally complain of exercise intolerance and dyspnoea as key clinical correlates. Cardiac well extracardiac components play a role for the limited capacity, including an impaired cardiac peripheral vascular reserve, limitation in mechanical ventilation and/or gas exchange reduced pulmonary skeletal muscle dysfunction iron deficiency/anaemia. Although most these can be differentiated quantified through analysis by cardiopulmonary testing (CPET), information provided objective measures performance has not been systematically considered recent algorithms/scores HFpEF diagnosis, neither European nor US groups. The current consensus statement Heart Failure Association (HFA) Preventive Cardiology (EAPC) Society (ESC) aims at outlining its pathophysiological, prognostic insights, addressing implications thorough functional evaluation from diagnostic algorithm to pathophysiology treatment perspectives HFpEF. Along goals, we provide specific evidence that CPET is standard assessing, quantifying, differentiating origin impairment even more so when combined echocardiography invasive haemodynamic evaluation. This will lead improved quality diagnosis applying proposed scores may also help implement progressive characterization phenotypes, critical step toward delivery phenotype‐specific treatments.

Language: Английский

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension DOI
Marc Humbert, Gábor Kovács, Marius M. Hoeper

et al.

European Heart Journal, Journal Year: 2022, Volume and Issue: 43(38), P. 3618 - 3731

Published: Aug. 26, 2022

Language: Английский

Citations

2237
2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension DOI Open Access
Marc Humbert, Gábor Kovács, Marius M. Hoeper

et al.

European Respiratory Journal, Journal Year: 2022, Volume and Issue: 61(1), P. 2200879 - 2200879

Published: Aug. 25, 2022

2022 ESC/ERS pulmonary hypertension guidelines incorporate changes and adaptations focusing on clinical management https://bit.ly/3QtUvb4

Language: Английский

Citations

1245
Role of Diastolic Stress Testing in the Evaluation for Heart Failure With Preserved Ejection Fraction DOI Open Access
Masaru Obokata, Garvan C. Kane, Yogesh N.V. Reddy

et al.

Circulation, Journal Year: 2016, Volume and Issue: 135(9), P. 825 - 838

Published: Dec. 31, 2016

Diagnosis of heart failure with preserved ejection fraction (HFpEF) is challenging and relies largely on demonstration elevated cardiac filling pressures (pulmonary capillary wedge pressure). Current guidelines recommend use natriuretic peptides (N-terminal pro-B type peptide) rest/exercise echocardiography (E/e' ratio) to make this determination. Data support practice are conflicting.Simultaneous echocardiographic-catheterization studies were prospectively conducted at rest during exercise in subjects invasively proven HFpEF (n=50) participants dyspnea but no identifiable pathology (n=24).N-Terminal peptide levels below the level considered exclude disease (≤125 pg/mL) 18% HFpEF. E/e' ratio was correlated directly measured pulmonary pressure (r=0.63, P<0.0001) (r=0.57, P<0.0001). Although specific, current poorly sensitive, identifying only 34% 60% basis resting echocardiographic data alone. Addition ratio>14) improved sensitivity (to 90%) thus negative predictive value, decreased specificity (71%).Currently proposed diagnostic sensitive. Adding improves value compromises specificity, suggesting that may help rule out These results question accuracy approaches alone reinforce testing using invasive noninvasive hemodynamic assessments definitively confirm or refute diagnosis HFpEF.URL: http://www.clinicaltrials.gov. Unique Identifier: NCT01418248.

Language: Английский

Citations

495
Pulmonary hypertension due to left heart disease DOI Creative Commons
Jean‐Luc Vachiéry, Ryan J. Tedford, Stephan Rosenkranz

et al.

European Respiratory Journal, Journal Year: 2018, Volume and Issue: 53(1), P. 1801897 - 1801897

Published: Dec. 13, 2018

Pulmonary hypertension (PH) is frequent in left heart disease (LHD), as a consequence of the underlying condition. Significant advances have occurred over past 5 years since 5th World Symposium on Hypertension 2013, leading to better understanding PH-LHD, challenges and gaps evidence. PH failure with preserved ejection fraction represents most complex situation, it may be misdiagnosed group 1 PH. Based latest evidence, we propose new haemodynamic definition for due LHD three-step pragmatic approach differential diagnosis. This includes identification specific "left heart" phenotype non-invasive probability PH-LHD. Invasive confirmation PH-LHD based accurate measurement pulmonary arterial wedge pressure and, patients high probability, provocative testing clarify Finally, recent clinical trials did not demonstrate benefit treating hypertension-approved therapies.

Language: Английский

Citations

475
Pathophysiology of the right ventricle and of the pulmonary circulation in pulmonary hypertension: an update DOI Creative Commons
Anton Vonk Noordegraaf, Kelly Chin, François Haddad

et al.

European Respiratory Journal, Journal Year: 2018, Volume and Issue: 53(1), P. 1801900 - 1801900

Published: Dec. 13, 2018

The function of the right ventricle determines fate patients with pulmonary hypertension. Since heart failure is consequence increased afterload, a full physiological description cardiopulmonary unit consisting both and vascular system required to interpret clinical data correctly. Here, we provide such its components, including functional interactions between load. This used framework for interpretation catheterisation as well imaging obtained by echocardiography or magnetic resonance imaging. Finally, an update provided on latest insights in pathobiology ventricular failure, key pathways molecular adaptation pressure overloaded ventricle. Based these outcomes, future directions research are proposed.

Language: Английский

Citations

453
Cardiac natriuretic peptides DOI
Jens P. Goetze, Benoit G. Bruneau, Hugo R. Ramos

et al.

Nature Reviews Cardiology, Journal Year: 2020, Volume and Issue: 17(11), P. 698 - 717

Published: May 22, 2020

Language: Английский

Citations

394
Cardiopulmonary Exercise Testing DOI Creative Commons
Marco Guazzi,

Francesco Bandera,

Cemal Ozemek

et al.

Journal of the American College of Cardiology, Journal Year: 2017, Volume and Issue: 70(13), P. 1618 - 1636

Published: Sept. 1, 2017

Language: Английский

Citations

374
The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography DOI Open Access
Patrizio Lancellotti, Patricia A. Pellikka, Werner Budts

et al.

European Heart Journal - Cardiovascular Imaging, Journal Year: 2016, Volume and Issue: 17(11), P. 1191 - 1229

Published: Oct. 21, 2016

A unique and highly versatile technique, stress echocardiography (SE) is increasingly recognized for its utility in the evaluation of non-ischaemic heart disease. SE allows simultaneous assessment myocardial function haemodynamics under physiological or pharmacological conditions. Due to diagnostic prognostic value, has become widely implemented assess various conditions other than ischaemic It thus essential establish guidance applications performance area This paper summarizes these recommendations.

Language: Английский

Citations

366
Cardiopulmonary Exercise Testing in Heart Failure DOI
Rajeev Malhotra,

Kristian Bakken,

Emilia D’Elia

et al.

JACC Heart Failure, Journal Year: 2016, Volume and Issue: 4(8), P. 607 - 616

Published: June 11, 2016

Language: Английский

Citations

362
Abnormal right ventricular-pulmonary artery coupling with exercise in heart failure with preserved ejection fraction DOI Open Access
Barry A. Borlaug, Garvan C. Kane, Vojtěch Melenovský

et al.

European Heart Journal, Journal Year: 2016, Volume and Issue: 37(43), P. 3293 - 3302

Published: June 26, 2016

Background Exercise intolerance is common in people with heart failure and preserved ejection fraction (HFpEF). Right ventricular (RV) dysfunction has been shown at rest HFpEF but little data are available regarding dynamic RV-pulmonary artery (PA) coupling during exercise. Methods results Subjects (n = 50) controls 24) prospectively underwent invasive cardiopulmonary exercise testing using high-fidelity micromanometer catheters along simultaneous assessment of RV left (LV) mechanics by echocardiography. Compared rest, subjects displayed systolic diastolic (RV s′ e′), impaired LV e′, higher biventricular filling pressures, pulmonary pressures. On exercise, less increase stroke volume, rate, cardiac output (CO), blunted CO relative to O2 consumption (VO2). Enhancement function on was compared controls. Exercise-induced PA vasodilation reduced correlation greater venous hypoxia. Elevations pressures limitations reserve were strongly correlated abnormal enhancement the stress. Conclusions In addition limited reserve, patients display that associated high inadequate responses. These findings highlight importance suggest novel therapies targeting myocardial both right may be effective improve clinical status.

Language: Английский

Citations

333