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Title: | Pulmonary vascular response to exercise in symptomatic heart failure with reduced ejection fraction and pulmonary hypertension | Authors: | VERBRUGGE, Frederik DUPONT, Matthias BERTRAND, Philippe NIJST, Petra GRIETEN, Lars DENS, Jo Verhaert, David Janssens, Stefan Tang, W. H. Wilson MULLENS, Wilfried |
Issue Date: | 2015 | Publisher: | WILEY-BLACKWELL | Source: | EUROPEAN JOURNAL OF HEART FAILURE, 17 (3), p. 320-328 | Abstract: | Aims: To study pulmonary vascular response patterns to exercise in heart failure with reduced ejection fraction (HFrEF) and pulmonary hypertension (PH). Methods and results: In this prospective single-centre cohort study, consecutive symptomatic HFrEF patients (n = 40) with mean pulmonary arterial pressure (MPAP) 25 mmHg, pulmonary artery wedge pressure (PAWP) >15 mmHg, and cardiac index <2.5 L/min.m(2), received protocol-driven titrated sodium nitroprusside (SNP) and diuretics to reach mean arterial blood pressure 65-75 mmHg and PAWP 15 mmHg. Patients performed symptom-limited supine bicycle testing under continued SNP administration. Afterwards, SNP was gradually withdrawn, renin-angiotensin system blockers uptitrated, and hydralazine added to maintain haemodynamic targets. Subsequently, bicycle testing was repeated. Patients presented with pulmonary vascular resistance (PVR) = 3.8 1.4 Wood Units at rest, decreasing to 2.9 +/- 0.9 Wood Units after decongestion, with PH was completely reversed (MPAP <25 mmHg) in 22%. From rest to maximal exercise, the cardiac index did not change significantly (P = 0.334 under SNP; P-value = 0.552 under oral therapy). A dynamic exercise-induced PVR increase >3.5 Wood Units was noted in 19 patients (48%) under oral therapy vs. five (13%) under SNP. Such exercise-induced PVR increase was associated with a 33% relative decrease in right ventricular stroke work index (P = 0.037). Conclusions: <p id="ejhf217-para-0003">Even after thorough decongestion and under continuous afterload reduction, PH secondary to HFrEF is completely reversible in only a minority of patients. Others demonstrate an exercise-induced PVR increase, associated with impaired right ventricular stroke work, which might be ameliorated by nitric oxide donor support. | Notes: | Mullens, W (reprint author) [Verbrugge, Frederik H.; Dupont, Matthias; Bertrand, Philippe B.; Nijst, Petra; Grieten, Lars; Dens, Joseph; Verhaert, David; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, B-3600 Genk, Belgium. [Verbrugge, Frederik H.; Bertrand, Philippe B.; Nijst, Petra] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Grieten, Lars; Dens, Joseph; Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, Diepenbeek, Belgium. [Janssens, Stefan] Katholieke Univ Leuven, Univ Hosp Gasthuisberg, Dept Cardiovasc Dis, Leuven, Belgium. [Tang, W. H. Wilson] Cleveland Clin, Inst Heart & Vasc, Dept Cardiovasc Med, Cleveland, OH 44106 USA. wilfried.mullens@zol.be | Keywords: | Exercise test; Nitric oxide; Pulmonary hypertension; Systolic heart failure;exercise test; nitric oxide; pulmonary hypertension; systolic heart failure | Document URI: | http://hdl.handle.net/1942/18713 | ISSN: | 1388-9842 | e-ISSN: | 1879-0844 | DOI: | 10.1002/ejhf.217 | ISI #: | 000351079800012 | Rights: | © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2016 |
Appears in Collections: | Research publications |
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