DOI: 10.1161/circ.148.suppl_1.17833 ISSN: 0009-7322

Abstract 17833: Characterization of Central versus Peripheral Predominance of Exercise Limitation in Patients With Heart Failure and Preserved Ejection Fraction

Cheshta Prasad, Joseph Campain, Alexandra Minasian, Catharine Griskowitz, Ilya Giverts, Shaina McGinnis, Jennifer Rouvina, Alyssa Kowal, Katherine Kelly, Casey White, Peter Wagner, Rajeev Malhotra, Gregory Lewis
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogenous disorder in which abnormalities in both cardiac output (CO) and peripheral oxygen extraction (CavO 2 ) contribute to impaired oxygen uptake (VO 2 ). We investigated the predominant limitation to VO 2 , according to distinct HFpEF criteria, by examining the CO vs. VO 2 relationship during incremental exercise.

Methods: Participants underwent Cardiopulmonary Exercise Testing (CPET) with invasive hemodynamic assessment and were diagnosed with HFpEF based on characteristic symptoms and NTproBNP ≥125pg/mL, Supine PCWP ≥15mmHg, PCWP/CO ≥2mmHg/L/min or Peak PCWP ≥25mmHg. Calculated direct Fick CO versus VO 2 slope and peak exercise data were stratified by the expected relationship of CO(L/min) = 5хVO 2 (L/min) +5. The Mann Whitney U Test and t-test characterized those limited by cardiac output (Slope <5L/min) vs. peripheral extraction (Slope >5L/min). Results: In 425 dyspneic individuals meeting biomarker and/or hemodynamic criteria for HFpEF, 36% had predominantly peripheral limitation (Measured Peak CO > Expected). Among those with NTpro-BNP ≥125pg/mL or resting PCWP ≥15mmHg, or both (N=220) , 31% were peripherally limited. 41% of those with a PCWP/CO ≥2mmHg/mL/min or Peak PCWP ≥25mmHg, or both (N=205) , were peripherally limited. Among all peripherally limited patients (N=151), the percentage of females, NTpro-BNP levels, Hb levels, rest and peak Ca-vO 2 , and rest and peak PVR were significantly lower compared to the cardiac limited group (Table, N=274), while resting PCWP, LVEF and HR were similar (Table).

Conclusion: Despite meeting concurrent biomarker and/or hemodynamic criteria for HFpEF, peripheral-predominant limitation to exercise capacity is common which merits consideration when deploying interventions to augment exercise capacity in HFpEF.

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