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Title: | Heart failure with preserved ejection fraction: relevance of a dedicated dyspnoea clinic | Authors: | VERWERFT, Jan Soens, Lucie Wynants, Jokke Meysman, Marc Jogani, Siddharth Plein, Danielle Stroobants , Sarah HERBOTS, Lieven VERBRUGGE, Frederik |
Issue Date: | 2023 | Publisher: | OXFORD UNIV PRESS | Source: | EUROPEAN HEART JOURNAL, 44 (17) , p. 1544-1556 | Abstract: | Background and aims Heart failure with preserved ejection fraction (HFpEF) is a syndrome with a heterogeneous presentation. This study provides an in-;depth description of haemodynamic and metabolic alterations revealed by systematic assessment through cardiopulmonary exercise testing combined with exercise echocardiography (CPETecho) within a dedicated dyspnoea clinic. Methods and results Consecutive patients (n = 297), referred to a dedicated dyspnoea clinic using a standardized workup including CPETecho, with HFpEF diagnosed through a H2FPEF score >= 6 or HFA-PEFF score >= 5, were evaluated. A median of four haemodynamic/metabolic alterations was uncovered per patient: impaired stroke volume reserve (73%), impaired chronotropic reserve (72%), exercise pulmonary hypertension (65%), and impaired diastolic reserve (64%) were the most frequent cardiac alterations. Impaired peripheral oxygen extraction and a ventilatory limitation were present in 40% and 39%, respectively. In 267 patients (90%), 575 further diagnostic examinations were recommended (median of two tests per patient). Cardiac magnetic resonance imaging, coronary or amyloidosis workup, ventilation-perfusion scanning, and pulmonology referral were each recommended in approximately one out of three patients. In 293 patients (99%), 929 cardiovascular drug optimizations were performed (median of 3 modifications per patient). In 110 patients (37%), 132 cardiovascular interventions were performed, with ablation as the most frequent procedure. Conclusion Holistic workup of HFpEF patients within a multidisciplinary, dedicated dyspnoea clinic, including systematic implementation of CPETecho reveals various haemodynamic/metabolic alterations, leading to further diagnostic testing and potential treatment changes in the majority of cases. | Notes: | Verbrugge, FH (corresponding author), Univ Hosp Brussels, Ctr Cardiovasc Dis, Laarbeeklaan 101, B-1090 Jette, Belgium.; Verbrugge, FH (corresponding author), Vrije Univ Brussel, Fac Med & Pharm, Pleinlaan 2, B-1050 Elsene, Belgium. frederik.verbrugge@uzbrussel.be |
Keywords: | Diastolic heart failure;Dyspnoea;Echocardiography;Exercise test;Therapeutics | Document URI: | http://hdl.handle.net/1942/39974 | ISSN: | 0195-668X | e-ISSN: | 1522-9645 | DOI: | 10.1093/eurheartj/ehad141 | ISI #: | 000950351400001 | Rights: | The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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Heart failure with preserved ejection fraction_ relevance of a dedicated dyspnoea clinic.pdf | Published version | 1.59 MB | Adobe PDF | View/Open |
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