Author + information
- Shane Nanayakkaraa,b,
- Mark Haykowskya,b,
- Justin Mariania,b,
- Vanessa Van Empela,b,
- Micha Maedera,b,
- Donna Vizia,b and
- David Kayea,b
Background: Heart failure is a clinical diagnosis in which a stratification based on left ventricular ejection fraction (LVEF) has been applied to identify more homogeneous groups for the purpose of diagnosis and treatment. Within the group with HF with preserved ejection fraction (HFpEF), a range of phenotypic profiles are recognised, including impaired diastolic reserve and abnormal system vasodilator reserve. The impact of aging on the pathophysiology of HFpEF is unclear, and this is particularly relevant given HFpEF is largely a condition of older persons.
Objective: To investigate the influence of aging on the hemodynamics of HFpEF at rest and during exercise.
Methods: We assessed the hemodynamic and metabolic profile of 40 patients with HFpEF. Subjects underwent right heart catheterisation at rest and during supine cycle ergometry together with evaluation of arteriovenous oxygen extraction capacity. Patient were dichotomised by age into two groups; Group 1 (n=21) had a mean age of 62±7.5 and Group 2, mean age of 75±4.6.
Results: Patients in the older age group demonstrated reduced resting cardiac output (4.8±1.2 L/min vs 5.7±1.1 L/min). With exercise, older patients demonstrated a marked rise in a-vO2Diff (arteriovenous oxygen content difference; 10.8±1.8 vs 7.9±2.4mL, p=<0.001), driven by enhanced oxygen extraction (60.3±9.1% vs 44±12.1%, p<0.001) secondary to increased peripheral O2 diffusive conductance (36.6±13.9 vs. 26.1±14.1, p0.048). There was no significant difference in pulmonary capillary wedge pressure (PCWP; 30±7mHg vs 27±6, p=0.135), and no statistical difference in exercise cardiac output with increasing age (8.5±3.0 L/min vs 10.1±3.3 L/min, p=0.127).
Conclusions: Older HFpEF patients display a different physiological phenotype compared with younger patients, with a greater reliance on oxygen extraction rather than cardiac output to increase VO2 from rest to peak supine exercise. This finding highlights the importance in considering age when considering therapeutic options in patients with HFpEF.
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: 1250-282
- 2017 American College of Cardiology Foundation