Τίτλος:
Exercise testing in heart failure with preserved ejection fraction: an appraisal through diagnosis, pathophysiology and therapy – A clinical consensus statement of the Heart Failure Association and European Association of Preventive Cardiology of the European Society of Cardiology
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Patients with heart failure with preserved ejection fraction (HFpEF) universally complain of exercise intolerance and dyspnoea as key clinical correlates. Cardiac as well as extracardiac components play a role for the limited exercise capacity, including an impaired cardiac and peripheral vascular reserve, a limitation in mechanical ventilation and/or gas exchange with reduced pulmonary vascular reserve, skeletal muscle dysfunction and iron deficiency/anaemia. Although most of these components can be differentiated and quantified through gas exchange analysis by cardiopulmonary exercise testing (CPET), the information provided by objective measures of exercise performance has not been systematically considered in the recent algorithms/scores for HFpEF diagnosis, by neither European nor US groups. The current clinical consensus statement by the Heart Failure Association (HFA) and European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC) aims at outlining the role of exercise testing and its pathophysiological, clinical and prognostic insights, addressing the implications of a thorough functional evaluation from the diagnostic algorithm to the pathophysiology and treatment perspectives of HFpEF. Along with these goals, we provide a specific analysis of the evidence that CPET is the standard for assessing, quantifying, and differentiating the origin of dyspnoea and exercise impairment and even more so when combined with echocardiography and/or invasive haemodynamic evaluation. This will lead to improved quality of diagnosis when applying the proposed scores and may also help to implement the progressive characterization of the specific HFpEF phenotypes, a critical step toward the delivery of phenotype-specific treatments. © 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Συγγραφείς:
Guazzi, M.
Wilhelm, M.
Halle, M.
Van Craenenbroeck, E.
Kemps, H.
de Boer, R.A.
Coats, A.J.S.
Lund, L.
Mancini, D.
Borlaug, B.
Filippatos, G.
Pieske, B.
Περιοδικό:
European Journal of Heart Failure
Εκδότης:
John Wiley and Sons Ltd
Λέξεις-κλειδιά:
anemia; artery malformation; Article; cardiac energetics; cardiopulmonary exercise test; cardiovascular parameters; chronotropic incompetence; clinical effectiveness; clinical feature; comorbidity; consensus development; detection algorithm; diabetes mellitus; disorders of mitochondrial functions; Doppler echocardiography; dyspnea; echocardiography; energy transfer; evidence based medicine; exercise stress echocardiography; functional assessment; gas exchange; heart failure with preserved ejection fraction; heart muscle oxygen consumption; heart output; heart performance; hemodynamic monitoring; human; invasive procedure; iron deficiency; left atrial myopathy; lung mechanics; medical society; mitral valve regurgitation; myopathy; nonhuman; obesity; pathophysiology; phenotype; physical performance; prognosis; pulmonary hypertension; pulmonary vascular disease; six minute walk test; vein malformation; cardiology; dyspnea; exercise test; exercise tolerance; heart failure; heart stroke volume; physiology, Cardiology; Dyspnea; Exercise Test; Exercise Tolerance; Heart Failure; Humans; Stroke Volume
