Variability of post-exercise pulmonary capillary wedge pressure recovery. Implications for noninvasive echocardiographic diagnostics

Abstract

Aim. The aim of our study was to assess the course of immediate post-exercise pulmonary capillary wedge pressure (PCWP) changes to identify the optimal time window for the noninvasive diagnostics of exercise-induced PCWP elevation. Methods and Results. Seventy-one patients at risk of heart failure with normal left ventricular ejection fraction underwent simultaneous exercise echocardiography and right heart catheterization. The ratio of early left ventricular filling velocity (E) to early diastolic mitral annular velocity (e') was used to predict noninvasively exercise-induced PCWP elevation. Fifty-one patients had exercise-induced PCWP elevation ≥ 8 mmHg and reached peak exercise PCWP ≥ 20 mmHg. Rapid post-exercise recovery of PCWP within 2 min was achieved in 18 (35.3%) patients. Intermediate postexercise PCWP recovery at 3 and 4 min was found in 16 (31.4%) patients while late post-exercise PCWP recovery (≥ 5 min) was achieved in 17 (33.3%) patients. Conclusion. The course of post-exercise PCWP recovery is highly variable, and a significant proportion of patients have only a brief period (≤ 2 min) of exercise-induced PCWP elevation. This fact should be taken into account in noninvasive assessment of exercise-induced PCWP.

Can we diagnose isolated, exercise-induced heart failure with normal ejection fraction?

“…Post-exercise acquisition of Doppler data may affect E and e' values and artificially decrease the E/e' ratio in patients with rapid recovery of exerice-induced diastolic dysfunction. Meluzin et al 19 described normalization of exercise-induced elevation in PCWP within the first post-exercise minute in 13.7% of patients. Rapid post-exercise PCWP recovery within 2 minutes was achieved in 35.3% of patients.…”