Diffusion Capacity and Mortality in Patients With Pulmonary Hypertension Due to Heart Failure With Preserved Ejection Fraction

Hoeper, Marius M.; Meyer, Katrin; Rademacher, Jessica; Fuge, Jan; Welte, Tobias; Olsson, Karen M.

doi:10.1016/j.jchf.2015.12.016

Cited by 110 publications

(108 citation statements)

References 39 publications

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“…The phenotype of the patients described by TRIP et al [9] resembled CPFE, but the characteristic CT findings were absent, leading the authors to hypothesise that such patients may have a unique, smoking-related pulmonary vasculopathy. In a more recent paper, our group came to similar conclusions in patients with a low DLCO and combined pre-and post-capillary PH because of heart failure with preserved ejection fraction [12]. …”

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confidence: 57%

More on idiopathic pulmonary arterial hypertension with a low diffusing capacity

et al. 2017

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Pulmonary arterial hypertension (PAH) is defined by the presence of pre-capillary pulmonary hypertension (PH) in the absence of underlying causes such as lung diseases, chronic thromboembolic pulmonary hypertension (CTEPH) or other rare conditions [1,2]. While the idiopathic form of PAH (IPAH) was originally described as a disease affecting primarily younger women [3,4], it is now increasingly being diagnosed in elderly patients, many of whom present with cardiopulmonary comorbidities, which can make the exact diagnostic classification of such patients difficult [5][6][7][8].In 2013, TRIP et al.[9] described a "new" IPAH phenotype of predominantly elderly men with severe pre-capillary PH and a low diffusing capacity of the lungs for carbon monoxide (DLCO). Most of these patients had a smoking history but relatively well-preserved lung function, and 32% had normal findings on chest computed tomography (CT). The authors discussed the possibility that their patients may have had a variant of combined pulmonary fibrosis and emphysema (CPFE), a disease characterised by a distinct CT pattern of upper-lobe-predominant emphysema and lower-lobe-predominant fibrosis with relatively well-preserved lung function, low DLCO, hypoxaemia and a high prevalence of PH [10,11]. Like the patients described by TRIP et al. [9], patients with CPFE are typically elderly men with a history of heavy smoking. The phenotype of the patients described by TRIP et al. [9] resembled CPFE, but the characteristic CT findings were absent, leading the authors to hypothesise that such patients may have a unique, smoking-related pulmonary vasculopathy. In a more recent paper, our group came to similar conclusions in patients with a low DLCO and combined pre-and post-capillary PH because of heart failure with preserved ejection fraction [12].

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“…Cardiopulmonary exercise testing (CPET) plays an important role in properly phenotyping signs and symptoms of patients with heart failure with preserved ejection fraction (HFpEF) (6, 17, 27, 29, 34). Whether exercise intolerance linked to HFpEF manifests directly from pathophysiology of central (e.g., impaired inotropy and lusitropy (1, 5, 6, 24, 29)) and/or peripheral (e.g., skeletal muscle (21)) factors, there are immediately recognizable clinical implications associated with a reduced cardiac hemodynamic response during CPET in HFpEF.…”

Section: Introductionmentioning

confidence: 99%

“…However, clinically impactful factors including increased patient risk (3) and required resources (e.g., specialists and costs) make implementing the direct Fick method during routine CPET impractical. Therefore, because of the prognostic power associated with evaluating exercise cardiac hemodynamics in HFpEF (1, 5, 6, 17, 24, 29), there is a high-priority need to advance the understanding of unique scientific and methodologic factors influential to assessing noninvasive exercise cardiac hemodynamics in generalizable laboratory settings in HFpEF.…”

Section: Introductionmentioning

confidence: 99%

Comparisons of Noninvasive Methods Used to Assess Exercise Stroke Volume in Heart Failure with Preserved Ejection Fraction

Iterson

Olson

Borlaug

et al. 2017

Medicine &Amp; Science in Sports &Amp; Exercise

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Introduction Cardiopulmonary exercise testing (CPET) plays an important role in properly phenotyping signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The prognostic value of CPET is strengthened when accompanied by cardiac hemodynamic measurements. Although recognized as the ‘Gold’ standard, cardiac catheterization is impractical for routine CPET. Thus, advancing the scientific/methodologic understanding of noninvasive techniques for exercise cardiac hemodynamic assessment is clinically impactful in HFpEF. This study tested the concurrent validity of noninvasive acetylene gas (C2H2) uptake, echocardiography (ECHO), and oxygen pulse (O2pulse) for measuring/predicting exercise stroke volume (SV) in HFpEF. Methods 18 Caucasian HFpEF and 18 age/sex matched healthy controls participated in upright CPET (ages, 69±9 vs. 63±9 years). At rest, 20-W, and peak exercise, SV was measured at steady-state via C2H2 rebreathe (SVACET) and ECHO (SVECHO), whereas O2pulse was derived (=V O2/HR). Results Resting relationships between SVACET and SVECHO, SVECHO and O2pulse, or SVACET and O2pulse were significant in HFpEF (R2=0.30, 0.36, 0.67), but not controls (R2=0.07, 0.01, 0.09), respectively. Resting relationships persisted to 20-W in HFpEF (R2=0.70, 0.53, 0.70) and controls (R2=0.05, 0.07, 0.21), respectively. Peak exercise relationships were significant in HFpEF (R2=0.62, 0.24, 0.64), but only for SVACET vs. O2pulse in controls (R2=0.07, 0.04, 0.33), respectively. Standardized standard error of estimate (Std.SEE) between techniques was strongest in HFpEF at 20-W: SVACET vs. SVECHO=0.57±0.22; SVECHO vs. O2pulse=0.71±0.28; SVACET vs. O2pulse=0.56±0.22. Conclusion Constituting a clinically impactful step towards construct validation testing, these data suggest SVACET, SVECHO, and O2pulse demonstrate moderate-to-strong concurrent validity for measuring/predicting exercise SV in HFpEF.

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“…This could be relevant as e.g. heart failure has a negative impact on CO diffusing capacity [24]. It might well be that the changes in pulmonary capillary bed associated with lung emphysema are dominant over microvascular impairments associated with diabetes.…”

Section: Discussionmentioning

confidence: 99%

Transfer factor for carbon monoxide in patients with COPD and diabetes: results from the German COSYCONET cohort

et al. 2017

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BackgroundAn impairment of CO diffusing capacity has been shown in diabetic patients without lung disease. We analyzed how diffusing capacity in patients with COPD is affected by the concurrent diagnosis of diabetes.MethodsData from the initial visit of the German COPD cohort COSYCONET were used for analysis. 2575 patients with complete lung function data were included, among them 358 defined as diabetics with a reported physician diagnosis of diabetes and/or specific medication. Pairwise comparisons between groups and multivariate regression models were used to identify variables predicting the CO transfer factor (TLCO%pred) and the transfer coefficient (KCO%pred).ResultsCOPD patients with diabetes differed from those without diabetes regarding lung function, anthropometric, clinical and laboratory parameters. Moreover, gender was an important covariate. After correction for lung function, gender and body mass index (BMI), TLCO%pred did not significantly differ between patients with and without diabetes. The results for the transfer coefficient KCO were similar, demonstrating an important role of the confounding factors RV%pred, TLC%pred, ITGV%pred, FEV1%pred, FEV1/FVC, age, packyears, creatinine and BMI. There was not even a tendency towards lower values in diabetes.ConclusionThe analysis of data from a COPD cohort showed no significant differences of CO transport parameters between COPD patients with and without diabetes, if BMI, gender and the reduction in lung volumes were taken into account. This result is in contrast to observations in lung-healthy subjects with diabetes and raises the question which factors, among them potential anti-inflammatory effects of anti-diabetes medication are responsible for this finding.

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Diffusion Capacity and Mortality in Patients With Pulmonary Hypertension Due to Heart Failure With Preserved Ejection Fraction

Abstract: In patients with PH-HFpEF, a low DLCO is strongly associated with mortality.

Cited by 110 publications

References 39 publications

More on idiopathic pulmonary arterial hypertension with a low diffusing capacity

More on idiopathic pulmonary arterial hypertension with a low diffusing capacity

Comparisons of Noninvasive Methods Used to Assess Exercise Stroke Volume in Heart Failure with Preserved Ejection Fraction

Transfer factor for carbon monoxide in patients with COPD and diabetes: results from the German COSYCONET cohort

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