Exercise Intolerance in Heart Failure: Central Role for the Pulmonary System

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Abstract

We propose that abnormalities of the pulmonary system contribute significantly to the exertional dyspnea and exercise intolerance observed in patients with chronic heart failure. Interventions designed to address the deleterious pulmonary manifestations of heart failure may therefore yield promising improvements in exercise tolerance in this population. Pulmonary abnormalities are central to exercise limitation in patients with heart failure.

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Pulmonary hypertension due to left heart diseases.

John Coghlan, Teresa De Leon, Hunter Champion … (2013)

Pulmonary hypertension (PH), a common complication of left heart diseases (LHD), negatively impacts symptoms, exercise capacity, and outcome. Although the true prevalence of PH-LHD is unknown, a subset of patients might present significant PH that cannot be explained by a passive increase in left-sided filling pressures. The term "out-of-proportion" PH has been used to identify that population without a clear definition, which has been found less than ideal and created confusion. We propose a change in terminology and a new definition of PH due to LHD. We suggest to abandon "out-of-proportion" PH and to distinguish "isolated post-capillary PH" from "post-capillary PH with a pre-capillary component" on the basis of the pressure difference between diastolic pulmonary artery pressure and pulmonary artery wedge pressure. Although there is no validated treatment for PH-LHD, we provide insights into management and discuss completed and randomized trials in this condition. Finally, we provide recommendations for future clinical trials to establish safety and efficacy of novel compounds to target this area of unmet medical need. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Pulmonary vascular hemodynamic response to exercise in cardiopulmonary diseases.

Gregory Lewis, Eduardo Bossone, Robert Naeije … (2013)

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Clinical features, hemodynamics, and outcomes of pulmonary hypertension due to chronic heart failure with reduced ejection fraction: pulmonary hypertension and heart failure.

Wayne L Miller, Diane E. Grill, Barry Borlaug (2013)

The purpose of this study was to assess the clinical, functional, and hemodynamic characteristics of passive and mixed pulmonary hypertension (PH), compare outcomes, and contrast conventional and novel hemodynamic partition values in patients with chronic heart failure of reduced left ventricular ejection fraction (HFREF).