Author + information
- Yogesh N.V. Reddy,
- Mads Andersen,
- Masaru Obokata,
- Katlyn Koepp Borlaug,
- Vojtech Melenovsky,
- Thomas Olson and
- Barry Borlaug
Background: Aortic stiffening is believed to play a major role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF), but has never been assessed invasively during exercise. Sodium nitrite improves central hemodynamics in HFpEF, but its effect on individual components of arterial load is uncertain.
Methods: 22 controls and 98 HFpEF subjects undergoing invasive hemodynamic exercise testing with high fidelity micromanometers and simultaneous expired gas analysis were prospectively studied. Directly-measured radial artery pressure waves were converted to central aortic waveforms to determine left ventricular pulsatile load (aortic pulse pressure, PP; total arterial compliance index, TACI) and indices of wave reflection (backward pressure waves, Pb; reflection magnitude, RM, Augmentation Index, AIx).
Results: Arterial load and wave reflections were similar in HFpEF and controls at rest. With submaximal exercise at matched heart rates, HFpEF subjects displayed increased aortic PP (83±22 vs 71±16 mmHg, p=0.02) and reduced TACI (0.70±0.22 vs 1.52±0.56 ml/mmHg, p<0.0001) with similar RM and AIx. These arterial changes were coupled with higher LV filling pressures (32 ±7 vs 14±5 mmHg, p<0.0001) and depressed cardiac output reserve (3.4±0.9 vs 4.2±0.8 L/min/m2, p=0.0005). A subset of HFpEF underwent peak exercise assessment (n=42), and compared to controls (n=22), there was a lower peak HR (99±16bpm vs 121±16, p<0.0001), and higher AIx (17±13 vs 8± 11 %, p=0.007), Pb (35±13 vs 27±11mmHg; p=0.04) and RM (50[43,63] vs 41 [34,55] %, p=0.08). A subset of HFpEF subjects (n=56) received sodium nitrite or placebo in a double-blind, randomized fashion. As compared to placebo, nitrite improved TACI and reduced AIx at rest and during exercise. These changes were coupled with improved forward cardiac output during exercise and lower filling pressures (p<0.05 for all).
Conclusions: HFpEF subjects display marked limitations in large vessel arterial reserve during exercise associated with severely deranged central hemodynamics. Sodium nitrite therapy improves central aortic compliance and reflected load with exercise, contributing to its hemodynamic benefit.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Emerging Developments in HFpEF and Arryhthmias
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1250-267
- 2017 American College of Cardiology Foundation