TY - JOUR
T1 - The Value of Passive Leg Raise during Right Heart Catheterization in Diagnosing Heart Failure with Preserved Ejection Fraction
AU - Van De Bovenkamp, Arno A.
AU - Wijkstra, Niels
AU - Oosterveer, Frank P.T.
AU - Vonk Noordegraaf, Anton
AU - Bogaard, Harm Jan
AU - Van Rossum, Albert C.
AU - De Man, Frances S.
AU - Borlaug, Barry A.
AU - Handoko, M. Louis
N1 - Funding Information: Dr Noordegraaf is supported by the Netherlands Organization for Scientific Research (NWO; 918.16.610). Dr de Man is supported by NWO (917.18.338) and the Dutch Heart Foundation (DHF; 2018T059). Drs Noordegraaf, Bogaard, and de Man are supported by the Netherlands CardioVascular Research Initiative (2017-10, 2018-29). Dr Handoko is supported by DHF (2020T058). Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Background: Because of limited accuracy of noninvasive tests, diastolic stress testing plays an important role in the diagnostic work-up of patients with heart failure with preserved ejection fraction (HFpEF). Exercise right heart catheterization is considered the gold standard and indicated when HFpEF is suspected but left ventricular filling pressures at rest are normal. However, performing exercise during right heart catheterization is not universally available. Here, we examined whether pulmonary capillary wedge pressure (PCWP) during a passive leg raise (PLR) could be used as simple and accurate method to diagnose or rule out occult-HFpEF. Methods: In our tertiary center for pulmonary hypertension and HFpEF, all patients who received a diagnostic right heart catheterization with PCWP-measurements at rest, PLR, and exercise were evaluated (2014-2020). The diagnostic value of PCWPPLRwas compared with the gold standard (PCWPEXERCISE). Cut-offs derived from our cohort were subsequently validated in an external cohort (N=74). Results: Thirty-nine non-HFpEF, 33 occult-HFpEF, and 37 manifest-HFpEF patients were included (N=109). In patients with normal PCWPREST(<15 mmHg), PCWPPLRsignificantly improved diagnostic accuracy compared with PCWPREST(AUC=0.82 versus 0.69, P=0.03). PCWPPLR≥19 mmHg (24% of cases) had a specificity of 100% for diagnosing occult-HFpEF, irrespective of diuretic use. PCWPPLR≥11 mmHg had a 100% sensitivity and negative predictive value for diagnosing occult-HFpEF. Both cut-offs retained a 100% specificity and 100% sensitivity in the external cohort. Absolute change in PCWPPLRor V-wave derived parameters had no incremental value in diagnosing occult-HFpEF. Conclusions: PCWPPLRis a simple and powerful tool that can help to diagnose or rule out occult-HFpEF.
AB - Background: Because of limited accuracy of noninvasive tests, diastolic stress testing plays an important role in the diagnostic work-up of patients with heart failure with preserved ejection fraction (HFpEF). Exercise right heart catheterization is considered the gold standard and indicated when HFpEF is suspected but left ventricular filling pressures at rest are normal. However, performing exercise during right heart catheterization is not universally available. Here, we examined whether pulmonary capillary wedge pressure (PCWP) during a passive leg raise (PLR) could be used as simple and accurate method to diagnose or rule out occult-HFpEF. Methods: In our tertiary center for pulmonary hypertension and HFpEF, all patients who received a diagnostic right heart catheterization with PCWP-measurements at rest, PLR, and exercise were evaluated (2014-2020). The diagnostic value of PCWPPLRwas compared with the gold standard (PCWPEXERCISE). Cut-offs derived from our cohort were subsequently validated in an external cohort (N=74). Results: Thirty-nine non-HFpEF, 33 occult-HFpEF, and 37 manifest-HFpEF patients were included (N=109). In patients with normal PCWPREST(<15 mmHg), PCWPPLRsignificantly improved diagnostic accuracy compared with PCWPREST(AUC=0.82 versus 0.69, P=0.03). PCWPPLR≥19 mmHg (24% of cases) had a specificity of 100% for diagnosing occult-HFpEF, irrespective of diuretic use. PCWPPLR≥11 mmHg had a 100% sensitivity and negative predictive value for diagnosing occult-HFpEF. Both cut-offs retained a 100% specificity and 100% sensitivity in the external cohort. Absolute change in PCWPPLRor V-wave derived parameters had no incremental value in diagnosing occult-HFpEF. Conclusions: PCWPPLRis a simple and powerful tool that can help to diagnose or rule out occult-HFpEF.
KW - diuretic
KW - heart failure
KW - hypertension, pulmonary
KW - leg
KW - pulmonary wedge pressure
UR - http://www.scopus.com/inward/record.url?scp=85128800397&partnerID=8YFLogxK
U2 - https://doi.org/10.1161/CIRCHEARTFAILURE.121.008935
DO - https://doi.org/10.1161/CIRCHEARTFAILURE.121.008935
M3 - Article
C2 - 35311526
SN - 1941-3289
VL - 15
SP - e008935
JO - Circulation. Heart Failure
JF - Circulation. Heart Failure
IS - 4
ER -