Elsevier

Heart Failure Clinics

Volume 15, Issue 2, April 2019, Pages 229-239
Heart Failure Clinics

Resting and Exercise Doppler Hemodynamics: How and Why?

https://doi.org/10.1016/j.hfc.2018.12.003Get rights and content

Section snippets

Key points

  • Rest and exercise hemodynamics are useful in prognostic and therapeutic decision making across the spectrum of heart failure.

  • Several hemodynamic measures may appear normal at rest and require dynamic challenge, such as exercise, to provoke symptoms and reveal abnormal physiology.

  • Invasive cardiac catheterization remains the gold standard but may be limited by practicality; consequently, several echocardiographic and MRI parameters are becoming of increasing interest, particularly in regard to

Exercise Testing

Conventional exercise testing, performed on a treadmill or upright cycle, has the disadvantage of limiting access to peak imaging, so most studies are performed immediately postexercise. This has the disadvantage of potentially missing signals that rapidly dissipate. Supine exercise is more amenable to imaging, but the position changes preload, and therefore subjects begin at different points on the diastolic pressure-volume curve. Left ventricular (LV) volumes and stroke volume are larger when

Parameters

Several hemodynamic parameters are relevant to the failing heart (Table 1). Fundamentally, dyspnea occurs most commonly due to an elevation of LVFP, and accurate noninvasive estimation at rest and at peak exercise has remained the holy grail. Elevation of LVFP is primarily a compensatory response to preserve cardiac output in heart failure, with the magnitude of elevation indexed to workload proving highly prognostic.13 Beyond accurate LVFP measurement, invasive catheterization allows for

Diseases

Patients with heart failure, regardless of ejection fraction (EF), display varying levels of pulmonary vascular remodeling, left atrial dysfunction, dynamic mitral regurgitation, and peripheral oxygen extraction abnormalities. Consequently, the physiologic response to exercise is variable, and accurate and deep phenotypic identification allows for precise targeted therapy.

Cardiac Catheterization

Invasive hemodynamic testing, particularly with exercise, remains the gold standard for the accurate quantification of FP in all forms of heart failure.

Summary

Rest and exercise hemodynamics are useful in prognostic and therapeutic decision making across the spectrum of heart failure. Although invasive measurement remains the gold standard, noninvasive parameters are becoming increasingly useful, particularly in regard to quantifying ventriculo-vascular interactions. Currently, significant heterogeneity exists around exercise protocols, and there is a distinct need to develop consensus methodology and to validate these noninvasive measures in all

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    Disclosure Statement: The authors have nothing to disclose.

    Funding: S. Nanayakkara is supported by a scholarship from the National Heart Foundation of Australia and the Baker Bright Sparks program. D.M. Kaye is supported by a Fellowship from the National Health and Medical Research Council of Australia. The Baker Heart and Diabetes Institute is supported in part by the Victorian Government’s Operational Infrastructure Support Program.

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