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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/18713

Title: Pulmonary vascular response to exercise in symptomatic heart failure with reduced ejection fraction and pulmonary hypertension
Authors: Verbrugge, Frederik
Dupont, Matthias
Bertrand, Philippe
Nijst, Petra
Grieten, Lars
Dens, Jo
Verhaert, David
Janssens, Stefan
Tang, W. H. Wilson
Mullens, Wilfried
Issue Date: 2015
Citation: EUROPEAN JOURNAL OF HEART FAILURE, 17 (3), p. 320-328
Abstract: Aims: To study pulmonary vascular response patterns to exercise in heart failure with reduced ejection fraction (HFrEF) and pulmonary hypertension (PH). Methods and results: In this prospective single-centre cohort study, consecutive symptomatic HFrEF patients (n = 40) with mean pulmonary arterial pressure (MPAP) 25 mmHg, pulmonary artery wedge pressure (PAWP) >15 mmHg, and cardiac index <2.5 L/min.m(2), received protocol-driven titrated sodium nitroprusside (SNP) and diuretics to reach mean arterial blood pressure 65-75 mmHg and PAWP 15 mmHg. Patients performed symptom-limited supine bicycle testing under continued SNP administration. Afterwards, SNP was gradually withdrawn, renin-angiotensin system blockers uptitrated, and hydralazine added to maintain haemodynamic targets. Subsequently, bicycle testing was repeated. Patients presented with pulmonary vascular resistance (PVR) = 3.8 1.4 Wood Units at rest, decreasing to 2.9 +/- 0.9 Wood Units after decongestion, with PH was completely reversed (MPAP <25 mmHg) in 22%. From rest to maximal exercise, the cardiac index did not change significantly (P = 0.334 under SNP; P-value = 0.552 under oral therapy). A dynamic exercise-induced PVR increase >3.5 Wood Units was noted in 19 patients (48%) under oral therapy vs. five (13%) under SNP. Such exercise-induced PVR increase was associated with a 33% relative decrease in right ventricular stroke work index (P = 0.037). Conclusions: <p id="ejhf217-para-0003">Even after thorough decongestion and under continuous afterload reduction, PH secondary to HFrEF is completely reversible in only a minority of patients. Others demonstrate an exercise-induced PVR increase, associated with impaired right ventricular stroke work, which might be ameliorated by nitric oxide donor support.
Notes: Mullens, W (reprint author) [Verbrugge, Frederik H.; Dupont, Matthias; Bertrand, Philippe B.; Nijst, Petra; Grieten, Lars; Dens, Joseph; Verhaert, David; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, B-3600 Genk, Belgium. [Verbrugge, Frederik H.; Bertrand, Philippe B.; Nijst, Petra] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Grieten, Lars; Dens, Joseph; Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, Diepenbeek, Belgium. [Janssens, Stefan] Katholieke Univ Leuven, Univ Hosp Gasthuisberg, Dept Cardiovasc Dis, Leuven, Belgium. [Tang, W. H. Wilson] Cleveland Clin, Inst Heart & Vasc, Dept Cardiovasc Med, Cleveland, OH 44106 USA. wilfried.mullens@zol.be
URI: http://hdl.handle.net/1942/18713
DOI: 10.1002/ejhf.217
ISI #: 000351079800012
ISSN: 1388-9842
Category: A1
Type: Journal Contribution
Validation: ecoom, 2016
Appears in Collections: Research publications

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