Abstract 15081: Post-Exercise Oxygen Uptake Recovery Kinetics Are Associated With Cardiac Performance and Outcomes in Suspected Heart Failure With Preserved Ejection Fraction

IntroductionExercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF) reflects multi-organ dysfunction characteristic of a systemic disorder. We sought to determine if oxygen uptake (VO2) kinetic patterns may aid in resolution of cardiac-specific impairment during...

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Published in:Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A15081-A15081
Main Authors: Farrell, Robyn M, Sbarbaro, John, Hardin, Kathryn, Tanguay, Melissa, Blodgett, Jasmine, Schoenike, Mark, Cunningham, Thomas, Bailey, Cole S, Wooster, Luke, Lau, Emily, Namasivayam, Mayooran, Shah, Ravi V, Nayor, Matthew G, Ho, Jennifer E, Malhotra, Rajeev, Lewis, Gregory
Format: Article
Language:English
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Summary:IntroductionExercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF) reflects multi-organ dysfunction characteristic of a systemic disorder. We sought to determine if oxygen uptake (VO2) kinetic patterns may aid in resolution of cardiac-specific impairment during exercise.HypothesisDelayed kinetics of VO2 recovery will predict cardiac performance and heart failure (HF) outcomes in patients with suspected HFpEF.MethodsWe performed upright maximum incremental ramp cycle ergometry cardiopulmonary exercise testing with invasive hemodynamic monitoring in patients referred to a single center for evaluation of exertional dyspnea. Pulmonary capillary wedge pressure (PCWP), and direct Fick cardiac output (CO) were measured at rest and during each minute of exercise to derive ΔPCWP/ΔCO slopes (WQ). We assessed recovery O2 kinetics by measuring VO2 recovery delay (VO2RD), defined as the time it took for VO2 to fall below peak VO2 (defined by the highest 30 second median within the final minute of exercise). VO2RD >25s was evaluated as a prognostic cut point based on recent data linking VO2RD >25s to increased risk of mortality in HF with reduced LVEF. HF hospitalization and HF event-free survival were assessed by Cox regression models.ResultsAmong 342 patients with measured VO2 kinetics and normal LVEF (age 58±14.0, 55% female, BMI 29.5±6.2, LVEF 65±6.9%, mean±SD), VO2RD >25s was present in 72 patients (27%). VO2RD increased across quartiles of WQ (Figure, ANOVA p25s was associated with a higher hazard for HF hospitalization (HR 3.35, 95% CI 1.28-8.76, p=0.014) and combined HF or death (HR 2.1, 95% CI 1.04-4.18, p=0.039).ConclusionIn patients undergoing evaluation of dyspnea on exertion, abnormal VO2 recovery kinetics are associated with a steep increment in PCWP in response to exercise and lower HF-free survival.
ISSN:0009-7322
1524-4539
DOI:10.1161/circ.140.suppl_1.15081