To evaluate the role of exercise hemodynamic testing in the diagnostic workup for patients with dyspnea on exertion referred to the catheterization lab.
Heart failure with preserved ejection fraction (HFpEF) is a major public health problem that has no proven effective treatment. However, in practice, it's difficult to recognize early stage of HFpEF by resting hemodynamic study and echocardiography because the patients mainly complaint of dyspnea only during exercise but not resting condition. Accordingly, exercise stress test will be helpful to provide more information on pathophysiology, diagnosis, and severity in various cardiovascular diseases such as HFpEF, valvular heart disease, and chronic thromboembolic pulmonary hypertension. Thus, the broad objective of this proposal is to characterize the dynamic changes in cardiopulmonary mechanics during stress in patients with exertional dyspnea, establishing a comprehensive multimodality diagnostic approach to the evaluation of exercise intolerance. Specifically, this study will compare established and novel parameters derived from echocardiography and CPX with simultaneous, gold standard invasive measures of cardiovascular hemodynamics at rest and with exercise stress to define the role of noninvasive testing in the diagnostic workup for patients with dyspnea on exertion referred to the catheterization lab.
Study Type
OBSERVATIONAL
Enrollment
400
Assessment of pulmonary hemodynamics during exercise by right heart catheterization and cardiac function during exercise by a simultaneous transthoracic echocardiography
Samsung Medical Center
Seoul, South Korea
RECRUITINGProportion of exercise induced pulmonary artery wedge pressure >25 mmHg
Number of Participants with Diagnosis of earlier heart failure with preserved ejection fraction based on exercise PCWP
Time frame: during the procedure
Proportion of exercise induced pulmonary hypertension > 30 mmHg
Number of Participants with Diagnosis of pulmonary hypertension based on mean pulmonary pressure at peak exercise
Time frame: during the procedure
Correlation between peripheral venous pressure and right atrial pressure assumed by echocardiography
Correlation between peripheral venous pressure and right atrial pressure assumed by echocardiography
Time frame: during the procedure
Ventilatory mechanics
ratio of minute ventilation to carbon dioxide production (VE/VCO2)
Time frame: during the procedure
Aerobic capacity
peak oxygen consumption (VO2)
Time frame: during the procedure
coronary flow reserve
invasively measured coronary flow reserve
Time frame: during the procedure
index of microcirculatory resistance
invasively measured index of microcirculatory resistance
Time frame: during the procedure
Lactate level at peak exercise
Serum lactate level at peak exercise
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: during the procedure
LA stiffness
LA stiffness measured by LA strain/E/e' using Transthoracic echocardiography
Time frame: during the procedure
change of E/e' between at rest and peak exercise
The change of E/e' between at rest and peak exercise
Time frame: between at rest and peak exercise
Rates of rehospitalization due to heart failure
Rehospitalization due to heart failure
Time frame: 5 years follow-up
Rates of all-cause death
Follow-up death
Time frame: 5 years follow-up
The change of right ventricular systolic pressure (RVSP) between at rest and peak exercise
The change of RVSP between at rest and peak exercise
Time frame: between at rest and peak exercise
change of Tricuspid annular plane systolic excursion (TAPSE) between at rest and peak exercise
The change of TAPSE between at rest and peak exercise
Time frame: between at rest and peak exercise
change of S' between at rest and peak exercise
The change of S' between at rest and peak exercise
Time frame: between at rest and peak exercise