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Hemodynamic Profile of Patients With Heart Failure and Preserved Ejection Fraction Vary by Age

Shane Nanayakkara, Mark Haykowsky, Justin Mariani, Vanessa Van Empel, Micha T. Maeder, Donna Vizi & David M Kaye

abstract

BACKGROUND
Patients with heart failure with preserved ejection fraction (HFpEF) exhibit a range of cardiovascular phenotypic profiles modified by several common comorbidities. In particular, patients with HFpEF tend to be older; however, it is unclear whether the effects of cardiovascular aging per se modify the expression of HFpEF. We therefore sought to investigate the interaction between age and physiologic profile in patients with HFpEF.

METHODS AND RESULTS
We assessed the hemodynamic and metabolic profile of 40 patients with HFpEF. Patients underwent right heart catheterization at rest and during supine cycle ergometry, and were segregated into 2 groups by the median age of the cohort. Older patients with HFpEF demonstrated reduced resting cardiac output (4.8±1.2 L/min versus 5.7±1.1 L/min). With exercise, older patients demonstrated a marked rise in arteriovenous oxygen content difference (10.8±1.8 versus 7.9±2.4 mL, P≤0.001), driven by enhanced oxygen extraction. There was no significant difference in peak pulmonary capillary wedge pressure (30±7 mm Hg versus 27±6, P=0.135), including when indexed to workload (pulmonary capillary wedge pressure/W, 0.88 mm Hg/W versus 0.92; P=0.83).

CONCLUSIONS
Older patients with HFpEF display a different physiological phenotype compared with younger patients, with enhanced oxygen extraction and lower increment in cardiac output to increase oxygen consumption from rest to peak supine exercise. This finding highlights the importance in considering age when considering therapeutic options in patients with HFpEF.
   
citation Nanayakkara S, Haykowsky M, Mariani J, Van Empel V, Maeder M T, Vizi D, Kaye D M. Hemodynamic Profile of Patients With Heart Failure and Preserved Ejection Fraction Vary by Age. J Am Heart Assoc 2017; 6:.
   
type journal paper/review (English)
date of publishing 22-09-2017
journal title J Am Heart Assoc (6/9)
ISSN electronic 2047-9980
PubMed 28939710
DOI 10.1161/JAHA.116.005434