Background:Exercise hemodynamics can differentiate heart failure with preserved ejection fraction (HFpEF) from noncardiac dyspnea. However, respiratory pressure swings may impact hemodynamic measurements, potentially leading to misdiagnosis of HFpEF. Moreover, threshold values for abnormal hemodynamic response indicative of HFpEF are not universally accepted. Thus, we sought to evaluate the impact of respiratory pressure swings on hemodynamic data interpretation as well as the concordance among 3 proposed exercise hemodynamic criteria for HFpEF: (1) end-expiratory pulmonary artery wedge pressure (PAWP_exp) ≥25 mm Hg; (2) PAWP_exp/cardiac output slope >2 mm Hg/L per minute; and (3) respiratory-averaged (avg) mean pulmonary artery pressure >30 mm Hg, total pulmonary resistance_avg >3 WU, PAWP_avg ≥20 mm Hg.Methods:Fifty-seven patients with unexplained dyspnea (70% women, 70±9 years) underwent exercise cardiac catheterization. The difference between end-expiratory and averaged hemodynamic values, as well as the concordance among the 3 hemodynamic definitions of HFpEF, were assessed.Results:End-expiratory hemodynamics measurements were higher than values averaged across the respiratory cycle. During exercise, a larger proportion of patients exceeded the threshold of 25 mm Hg for PAWP_exp rather than for PAWP_avg (70% versus 53%, P<0.01). The concordance of 3/3 HFpEF exercise hemodynamic criteria was recorded in 70% of patients. PAWP_exp/cardiac output slope identified HFpEF more frequently than the other 2 criteria (81% versus 64% to 69%), incorporating over 97% of abnormal responses to the latter. Patients with 3/3 positive criteria had worse clinical, gas-exchange, and hemodynamic profiles.Conclusions:Respiratory pressure swings impact on the exercise hemodynamic definitions of HFpEF that provide discordant results in 30% of patients. Equivocal diagnoses of HFpEF might be limited by adopting the most sensitive and inclusive criterion alone (ie, PAWP_exp/cardiac output slope).

中文翻译：

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有创运动血流动力学诊断射血分数保留的心力衰竭的当前局限性

背景：运动血流动力学可以区分射血分数保留的心力衰竭 (HFpEF) 和非心源性呼吸困难。然而，呼吸压力波动可能会影响血流动力学测量，可能导致 HFpEF 的误诊。此外，指示 HFpEF 的异常血流动力学反应的阈值并未被普遍接受。因此，我们试图评估呼吸压力波动对血流动力学数据解释的影响以及 HFpEF 的 3 个拟议运动血流动力学标准之间的一致性：（1）呼气末肺动脉楔压（PAWP _exp）≥25 mm Hg；(2) PAWP _exp /心输出量斜率>2 mm Hg/L/min；(3) 呼吸平均 (avg) 平均肺动脉压 >30 mm Hg，总肺阻力_avg >3 WU，PAWP _avg ≥20 mm Hg。方法：57 名不明原因呼吸困难患者（70% 女性，70±9 岁）接受了运动心导管术。评估了呼气末血流动力学值和平均血流动力学值之间的差异，以及 HFpEF 的 3 种血流动力学定义之间的一致性。结果：呼气末血流动力学测量值高于整个呼吸周期的平均值。在运动期间，更大比例的患者超过 PAWP _exp阈值 25 mmHg，而不是 PAWP _avg阈值（70% 对 53%，P <0.01）。在 70% 的患者中记录到 3/3 HFpEF 运动血流动力学标准的一致性。PAWP _exp/ 心输出量斜率比其他 2 个标准更频繁地识别 HFpEF（81% 对 64% 至 69%），包含超过 97% 的对后者的异常反应。符合 3/3 阳性标准的患者临床、气体交换和血流动力学特征较差。结论：呼吸压力波动对 HFpEF 的运动血流动力学定义有影响，在 30% 的患者中提供不一致的结果。HFpEF 的模棱两可的诊断可能会因仅采用最敏感和最具包容性的标准（即 PAWP _exp /心输出量斜率）而受到限制。