title: Pulmonary capillary wedge pressure during exercise and long-term mortality in patients with suspected heart failure with preserved ejection fraction.
abstract: OBJECTIVE
  In patients with suspected heart failure with preserved ejection fraction (HFpEF), invasive exercise testing may be considered when measurements at rest are inconclusive. However, the prognostic impact of invasive exercise testing is uncertain, so far.
  
  
  RESULTS
  We retrospectively analysed mortality in 355 patients [mean age 61.2 ± 11.3 years, 235 (66.2%) women] with unexplained dyspnoea and suspected HFpEF. During an invasive haemodynamic stress test pulmonary capillary wedge pressure (PCWP) at rest and the PCWP response to exercise, expressed as the ratio of PCWP at peak exercise to workload normalized to body weight [PCWL (mmHg/W/kg)], were recorded. Both PCWP at rest and PCWL were significant and independent predictors of long-term mortality. Adding PCWL to PCWP at rest improved reclassification of patients into survivors or non-survivors with a net reclassification improvement (NRI) of 0.56 (95% CI: 0.29-0.83; P < 0.001). Ten-year mortality was 6.6% in subjects with low PCWP at rest (≤ 12 mmHg) and low PCWL (≤ 25.5 mmHg/W/kg); 28.2% in patients with low PCWP and high PCWL and 35.2% in those with high PCWP and high PCWL. Compared with patients with low PCWP and low PCWL, the adjusted hazard ratio for mortality was 2.37 (95% CI: 1.09-5.17; P = 0.029) for the low-PCWP/high-PCWL group and 4.75 (95% CI: 1.90-11.84; P < 0.001) for patients with high PCWP/high PCWL.
  
  
  CONCLUSIONS
  In patients with suspected HFpEF, invasive exercise testing substantially improves prediction of long-term mortality. An excessive rise of PCWP during exercise despite normal PCWP at rest is associated with increased mortality and may be considered as early HFpEF.
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg • Bad Krozingen, Südring 15, Bad Krozingen 79189, Germany stephan.dorfs@universitaets-herzzentrum.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Dorfs
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg • Bad Krozingen, Südring 15, Bad Krozingen 79189, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Zeh
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg • Bad Krozingen, Südring 15, Bad Krozingen 79189, Germany.
authors.forename: Willibald
authors.initials: W
authors.lastname: Hochholzer
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg • Bad Krozingen, Südring 15, Bad Krozingen 79189, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Jander
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg • Bad Krozingen, Südring 15, Bad Krozingen 79189, Germany.
authors.forename: Rolf-Peter
authors.initials: RP
authors.lastname: Kienzle
authors.affiliation: Klinische Abteilung für Kardiologie, Universitäres Herzzentrum, Universitätsklinik Graz, Auenbruggerplatz 15, Graz, Austria.
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg • Bad Krozingen, Südring 15, Bad Krozingen 79189, Germany.
authors.forename: Franz Josef
authors.initials: FJ
authors.lastname: Neumann
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D006328:Cardiac Catheterization; D015444:Exercise / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012372:ROC Curve; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*
keywords: Exercise haemodynamics; Heart failure with preserved ejection fraction; Mortality; Pulmonary capillary wedge pressure