Background
Patients with heart failure and preserved ejection fraction (HFpEF) display elevation in left heart pressures, but it is unclear how this affects pulmonary gas transfer or its determinants at rest and during exercise.
Objectives
Compare measures of gas exchange at rest and during exercise in subjects with HFpEF to age and gender-matched controls.
Methods
HFpEF patients (n=20) and controls (n=26) completed a recumbent cycle ergometry exercise test with simultaneous measurement of ventilation and gas exchange. Diffusion of the lungs for carbon monoxide (DLCO) and subcomponents, pulmonary capillary blood volume (VC) and alveolar-capillary membrane conductance (DM), were measured at rest, matched low-intensity (20W), and peak exercise. Stroke volume was measured by transthoracic echocardiography to calculate cardiac output.
Results
Compared to controls, HFpEF subjects displayed impaired diastolic function and reduced exercise capacity. HFpEF subjects demonstrated 24% lower DLCO at rest (11.0±2.3 vs 14.4±3.3 mL/mmHg/min, p<0.01), related to reductions in both DM (18.1±4.9 vs 23.1±9.1 mL/mmHg/min, p=0.04), and VC (45.9±15.2. vs 58.9±16.2 mL, p=0.01). DLCO was lower in HFpEF compared to controls in all stages of exercise, yet its determinants showed variable responses. With low-level exercise, HFpEF subjects demonstrated greater relative increases in VC, coupled with heightened ventilatory drive and more severe symptoms of dyspnea compared to controls. At 20W exercise, DM was markedly reduced in HFpEF compared to controls. From 20W to peak exercise, there was no further increase in VC in HFpEF subjects, which in tandem with reduced DM, led to 30% reduction in DLCO at peak exercise (17.3±4.2 vs 24.7±7.1 mL/mmHg/min, p<0.01).
Conclusion
Patients with HFpEF display altered pulmonary function and gas exchange at rest and especially during exercise which contributes to exercise intolerance. Novel therapies that improve gas diffusion may be effective to improve exercise tolerance in patients with HFpEF.