title: Characteristics and outcomes of patients with heart failure and discordant findings by right-sided heart catheterization and cardiopulmonary exercise testing.
abstract: There are limited data integrating findings on right-sided cardiac catheterization and cardiopulmonary exercise testing in ambulatory patients with heart failure. In this study, 187 outpatients with HF referred to the Duke Medical Center for consideration of advanced HF therapies were retrospectively evaluated. All patients had undergone right-sided cardiac catheterization and cardiopulmonary exercise testing; the median cardiac index (CI) was 2.0 L/min/m2 (interquartile range 1.7 to 2.3), and the median peak oxygen consumption was 11.3 ml/kg/min (interquartile range 9.2 to 13.8). Despite aggressive medical therapy, medical management had failed in 97 patients (52%) at 18 months, defined as left ventricular assist device implantation, cardiac transplantation, or death. After multivariate adjustment, factors associated with failure of optimal medical management included percentage achieved of predicted peak oxygen consumption, low CI (i.e., <2 L/min/m2), left ventricular size, and exercise time. Patients with discordant findings on right-sided cardiac catheterization and cardiopulmonary exercise testing were common, occurring in 88 patients (47%). The most common profile was preserved CI but reduced functional capacity, and these patients remained at high risk for requiring advanced therapies, whereas patients with reduced CIs but preserved exercise capacity were uncommon. In conclusion, low CI was independently associated with higher rates of death, transplantation, and left ventricular assist device implantation in this study. Also, patients with preserved CIs at rest but poor functional capacity, so-called cardiac insufficiency, were commonly encountered and had poor outcomes with medical management.
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Chetan B
authors.initials: CB
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. Electronic address: adam.devore@duke.edu.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Wojdyla
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Carmelo A
authors.initials: CA
authors.lastname: Milano
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D018450:Disease Progression; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016277:Ventricular Function, Left / Q000502:physiology*