Relationship between resting hemodynamic parameters and exercise capacity in patients with advanced heart failure: a single-centre experience
U Radak, S Borovic, D Kosevic, J Stefanovic Neskovic, J Miladinovic, B Milovanovic, N Andjelkovic, M BojicAbstract
Background
Exercise intolerance is a cardinal feature of advanced heart failure (HF) and is commonly assessed by peak oxygen uptake (peak VO₂) during cardiopulmonary exercise testing (CPET). Right heart catheterization (RHC) provides comprehensive invasive hemodynamic assessment. Together, these two diagnostic procedures provide crucial data to guide further HF management; however, the associations between individual hemodynamic parameters and exercise capacity in advanced HF are not fully established.
Purpose
To evaluate the associations between peak VO₂ and key invasive hemodynamic parameters in patients with advanced HF.
Methods
We retrospectively analysed 40 patients with advanced HF who underwent comprehensive evaluation according to our centre’s advanced HF protocol, including RHC and CPET. RHC and CPET were performed a median of 1 day apart (IQR 1–2.25 days). All patients were hemodynamically stable at the time when diagnostic procedures were done, without the need for inotropic support, and were classified as NYHA III (including IIIb) or IV (ACC/AHA stage D), INTERMACS profiles 4–5. Resting hemodynamic parameters included pulmonary capillary wedge pressure (PCWP), pulmonary vascular resistance (PVR), cardiac index (CI), and pulmonary artery pulsatility index (PAPi). Peak VO₂ was obtained from CPET. Due to non-normal distribution of key variables, associations between peak VO₂ and hemodynamic variables were assessed using Spearman correlation.
Results
A total of 40 patients with advanced HF underwent resting RHC and CPET. Mean peak VO₂ was 14.0 ± 4.3 ml/kg/min. Peak VO₂ correlated moderately with CI (ρ = 0.4, p = 0.011) and inversely with PCWP (ρ = -0.33, p = 0.039). A weaker positive association was observed with PAPi (ρ = 0.37, p = 0.019), while no significant association was found with PVR (ρ = -0.10, p = 0.56).
Conclusions
The findings suggest that not all resting hemodynamic metrics commonly used in advanced HF equally reflect functional limitation. In patients with advanced HF, exercise capacity is associated with multiple resting invasive hemodynamic domains. Cardiac index and filling pressures demonstrated the strongest association with peak VO₂, whereas pulmonary vascular resistance and pulmonary artery pulsatility index showed weaker or absent relationships with exercise capacity.Table 1.Baseline characteristics.For image description, please refer to the figure legend and surrounding text.Figure 1.Correlation analysis.For image description, please refer to the figure legend and surrounding text.