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• W2893096877 abstract "Provocative testing during right heart catheterization (RHC) is gaining increasing acceptance to evaluate cardiac and pulmonary vascular contributions to dyspnea. For this purpose, the use of cycle ergometry at measured work rates has been recommended as a physiologically relevant and sensitive stressor, but also increases the complexity of the investigation. A pilot experience was undertaken to examine the feasibility and diagnostic utility of a submaximal cycle ergometry protocol performed during RHC. The program was initiated in July, 2016. Patients referred for invasive evaluation of dyspnea of unclear etiology or suspected pulmonary hypertension underwent standard diagnostic RHC. Patients were then transferred to a cycle ergometer in a semi-upright position, and hemodynamics were assessed at rest, then at Light Intensity and Moderate Intensity submaximal exercise stages if tolerated. Hemodynamic diagnoses at rest were assigned based on guideline recommendations and exercise hemodynamic diagnoses were assigned based on sex-specific reference ranges developed by our laboratory. Between July 2016 and March 2018, 59 patients (61 ± 15 years, 53% female) were referred for invasive exercise hemodynamic evaluation. The clinical indications were dyspnea of unclear etiology in 32 (54%) and suspected pulmonary hypertension in 27 (46%). Resting hemodynamic assessment was performed in all patients and the exercise protocol was initiated in 56. In three (5%) cases, exercise hemodynamic evaluation was not performed based on concerns regarding safety. Ultrasound guided vascular access was obtained from antecubital veins in 52 (88%) and internal jugular veins in seven patients (12%). Table 1 details fluoroscopic exposures and procedure duration. The Light Intensity exercise stage (25 ± 9 Watts) was completed in 56 (95%), while Moderate Intensity exercise stage (56 ± 20 Watts)was completed in 29 (49%) patients. Figure 1 illustrates the hemodynamic classification at rest and after the exercise protocol. At rest, 35 patients (59%) had normal hemodynamics; however after the exercise protocol, the number of patients with normal hemodynamics declined to 20 (34%). Exercise induced pulmonary hypertension related to left heart disease (PH-LHD) was disclosed in 13 (37%) of 35 patients with normal resting hemodynamics. In this prospective series, a submaximal, cycle ergometry protocol performed during RHC was possible in 95% of the cohort referred. The intervention revealed hemodynamic abnormalities in over one-third of patients with normal resting hemodynamics. Exercise induced PH-LHD was the most frequently disclosed hemodynamic abnormality. This study also included prospective assessments of patient reported outcomes of breathlessness.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W2893096877 date "2018-10-01" @default.
• W2893096877 modified "2023-09-26" @default.
• W2893096877 title "FEASIBILITY OF EXERCISE HEMODYNAMIC EVALUATION IN THE CLINICAL CARDIAC CATHETERIZATION LABORATORY" @default.
• W2893096877 doi "https://doi.org/10.1016/j.cjca.2018.07.358" @default.
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