Abstract 15124: Upright Exercise Hemodynamic Profiles Effectively Risk Stratify Patients With Heart Failure With Preserved Ejection Fraction and Elevated Resting Filling Pressures

Introduction:A resting supine pulmonary capillary wedge pressure (rsPCWP) of ? 15 mmHg is considered a hemodynamic ?gold standard? criteria for diagnosing heart failure with preserved ejection fraction (HFpEF). Whether normal upright exercise PCWP confers a favorable prognosis when rsPCWP is elevated is unknown.Hypothesis:Among patients with elevated rsPCWP and a normal PCWP increase relative to cardiac output (PCWP/CO < 2 mmHg/L/min) during exercise will have superior HF-event free survival compared to individuals with elevated rsPCWP and abnormal PCWP/CO ? 2mmHg/L/min.Methods:We performed upright maximum incremental ramp cycle ergometry cardiopulmonary exercise testing with invasive hemodynamic monitoring in patients referred to a single center for evaluation of exertional dyspnea. At rest and each minute of exercise direct Fick CO and PCWP were measured to derive PCWP/CO slopes and patient outcomes were assessed with Cox regression models.Results:In 182 patients with rsPCWP ? 15mmHg and normal LVEF (age 60?14, 54% female, BMI 31?7, LVEF 65?7%; mean?SD) PCWP/CO slope was < 2 mmHg/L/min in 72 patients and ? 2mmHg/L/min in 110. After adjustment for age, sex, and BMI (Figure), PCWP/CO< 2mmHg/L/min was associated with a lower hazard for combined HF or death (hazard ratio HR=0.29, p=0.007), HF alone (HR=0.35, trend at p=0.067), and death (HR=0.29, p=0.028) in comparison with PCWP/CO ? 2mmHg/L/min. The 95% confidence intervals were [0.119, 0.716], [0.113,1.08] and [0.072, 0.829], respectively.Conclusion:A normal upright PCWP/CO slope of < 2 mmHg/L/min is associated with favorable outcomes in patients with elevated rsPCWP. These findings highlight a potentially important role of assessing exercise hemodynamics in patients with suspected HFpEF, even when rsPCWP is elevated.