Systemic Arterial Oxygen Levels Differentiate Pre- and Post-capillary Predominant Hemodynamic Abnormalities During Exercise in Undifferentiated Dyspnea on Exertion

•Even very elevated pulmonary capillary wedge pressure during exercise is not sufficient to lead to hypoxemia.•Exercise O2 saturation levels correlate with invasive hemodynamic profiles.•Hypoxemia with exercise should prompt consideration of pulmonary vascular disease. Whether systemic oxygen levels...

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Published in:Journal of cardiac failure 2024-01, Vol.30 (1), p.39-47
Main Authors: HARDIN, KATHRYN M., GIVERTS, ILYA, CAMPAIN, JOSEPH, FARRELL, ROBYN, CUNNINGHAM, THOMAS, BROOKS, LIANA, CHRIST, ANASTASIA, WOOSTER, LUKE, BAILEY, COLE S., SCHOENIKE, MARK, SBARBARO, JOHN, BAGGISH, AARON, NAYOR, MATTHEW, HO, JENNIFER E., MALHOTRA, RAJEEV, SHAH, RAVI, LEWIS, GREGORY D.
Format: Article
Language:English
Subjects:
Aged
cardiomyopathy
Dyspnea - diagnosis
Exercise Test
Female
Heart Failure
Hemodynamics
Humans
hypoxemia
Hypoxia
Male
Middle Aged
Oxygen
Physical Exertion
pulmonary hypertension
Pulmonary Wedge Pressure
Stroke Volume
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Summary:•Even very elevated pulmonary capillary wedge pressure during exercise is not sufficient to lead to hypoxemia.•Exercise O2 saturation levels correlate with invasive hemodynamic profiles.•Hypoxemia with exercise should prompt consideration of pulmonary vascular disease. Whether systemic oxygen levels (SaO2) during exercise can provide a window into invasively derived exercise hemodynamic profiles in patients with undifferentiated dyspnea on exertion is unknown. We performed cardiopulmonary exercise testing with invasive hemodynamic monitoring and arterial blood gas sampling in individuals referred for dyspnea on exertion. Receiver operator analysis was performed to distinguish heart failure with preserved ejection fraction from pulmonary arterial hypertension. Among 253 patients (mean ± SD, age 63 ± 14 years, 55% female, arterial O2 [PaO2] 87 ± 14 mmHg, SaO2 96% ± 4%, resting pulmonary capillary wedge pressure [PCWP] 18 ± 4mmHg, and pulmonary vascular resistance [PVR] 2.7 ± 1.2 Wood units), there was no exercise PCWP threshold, measured up to 49 mmHg, above which hypoxemia was consistently observed. Exercise PaO2 was not correlated with exercise PCWP (rho = 0.04; P = 0.51) but did relate to exercise PVR (rho = -0.46; P < 0.001). Exercise PaO2 and SaO2 levels distinguished left-heart-predominant dysfunction from pulmonary-vascular-predominant dysfunction with an area under the curve of 0.89 and 0.89, respectively. Systemic O2 levels during exercise distinguish relative pre- and post-capillary pulmonary hemodynamic abnormalities in patients with undifferentiated dyspnea. Hypoxemia during upright exercise should not be attributed to isolated elevation in left heart filling pressures and should prompt consideration of pulmonary vascular dysfunction. [Display omitted]
ISSN:1071-9164
1532-8414
DOI:10.1016/j.cardfail.2023.05.023