Invasive exercise haemodynamics: an oracle in heart failure with preserved ejection fraction diagnosis and prognostication.
Invasive exercise haemodynamics: an oracle in heart failure with preserved ejection fraction diagnosis and prognostication.
复制标题
侵入性运动血流动力学：心力衰竭的神谕，具有保留的射血分数诊断和预测。
DOI：
10.1002/ejhf.2774
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发表时间：
2023
影响因子：
18.2
通讯作者：
Lewis,GregoryD
中科院分区：
文献类型：
--
作者：
Mastoris,Ioannis;Campain,Joseph;Lewis,GregoryD
运动时发生不明原因呼吸困难的患者代表了具有诊断挑战性的人群。仅依赖于在休息时进行的心肺诊断测试，存在忽视运动暴露的生理异常的重大风险。运动侵入性血流动力学测量已成为评估和区分心源性与非心源性呼吸困难的重要方式，其价值越来越受到指南和主要共识文件的认可。1-3在本期杂志中，Omote等人4扩展了基于肺动脉导管的血流动力学测量在评价射血分数保留的疑似心力衰竭（HFpEF）中的重要性的知识基础。作者研究了临床指示仰卧位心肺运动试验（CPET）期间得出的异常侵入性血流动力学参数是否可预测心力衰竭相关住院或死亡。这项对764例不明原因呼吸困难患者的回顾性分析包括三组：（i）根据肺动脉楔压≥ 15 mmHg，静息时有HFpEF血流动力学证据的患者（rPAWP≥ 15，n= 384）;（ii）具有HFpEF血流动力学证据的患者，定义为仰卧位峰值运动PAWP≥ 25 mmHg（exPAWP≥ 25，n= 187）;和（iii）患有“非心源性呼吸困难”（NCD）的患者，其基于不仅具有rPAWP<15 mmHg和exPAWP< 25 mmHg，而且具有静息平均肺动脉压（PAP）<运动时平均PAP≤ 30 mmHg或PVR< 3 WU。该分组将毛细血管前肺血流动力学异常的患者仅与两个升高的PAWP组聚集在一起，与NCD组相比，可以说是增加了不良结局。中位随访期内
Patients with unexplained dyspnoea on exertion represent a diagnostically challenging population. Reliance on cardiopulmonary diagnostic testing solely performed at rest poses significant risk of overlooking physiologic abnormalities unmasked by exercise. Exercise invasive haemodynamic measurements have emerged as an important modality for assessment and differentiation of cardiac versus non-cardiac dyspnoea and their value is increasingly recognized by guidelines and major consensus documents. 1–3 In the current issue of the Journal, Omote et al. 4 expand the knowledge base underlying the importance of pulmonary arterial catheter-based haemodynamic measurements in the evaluation of suspected heart failure with preserved ejection fraction (HFpEF). The authors investigated whether abnormal invasive haemodynamic parameters derived during clinically-indicated supine cardiopulmonary exercise testing (CPET) predict heart failure-related hospitalizations or death. This retrospective analysis of 764 patients with unexplained dyspnoea included three groups:(i) patients with haemodynamic evidence of HFpEF at rest based on pulmonary arterial wedge pressure≥ 15 mmHg (rPAWP≥ 15, n= 384);(ii) patients with haemodynamic evidence of HFpEF defined by a supine peak exercise PAWP≥ 25mmHg (exPAWP≥ 25, n= 187); and (iii) patients with ‘non-cardiac dyspnoea’(NCD) based on not only having rPAWP< 15mmHg and exPAWP< 25 mmHg but also having resting mean pulmonary arterial pressure (PAP)< 20mmHg as well as pulmonary vascular resistance (PVR)< 3 Wood units (WU) at rest and mean PAP≤ 30mmHg or PVR< 3 WU with exercise. This grouping clusters those with abnormal pre-capillary pulmonary haemodynamics exclusively with the two elevated PAWP groups, arguably enriching for adverse outcomes in comparison to the NCD group. Over a median follow-up period