Heart Failure With Preserved Ejection Fraction (HFPEF) Clinical Trial
Official title:
Evaluation of Left Ventricular Filling Pressures During Exercise: Comparative Study, Catheterization Versus Echocardiography
Heart failure with preserved ejection fraction (HFPEF) is common and is a real public health
issue. Diagnosis, especially when there are no congestive signs, is difficult. It has been
shown that many patients with suspected HFPEF had left ventricular (LV) filling pressures
elevated only at exercise (normal at rest).
Using stress echocardiography and taking into account left atrial (LA) remodeling at rest as
a "memory" of chronic elevation of filling pressures. We believe that it is possible to
improve the noninvasive diagnosis of exercise elevation of the LV end-diastolic pressure
(LVEDP).
Purpose Heart failure with preserved ejection fraction (HFPEF) is common and is a real
public health issue. Diagnosis, especially when there are no congestive signs, is difficult.
It has been shown that many patients with suspected HFPEF had left ventricular (LV) filling
pressures elevated only at exercise (normal at rest).
Hypothesis Using stress echocardiography and taking into account left atrial (LA) remodeling
at rest as a "memory" of chronic elevation of filling pressures. We believe that it is
possible to improve the noninvasive diagnosis of exercise elevation of the LV end-diastolic
pressure (LVEDP).
Methods Prospective, monocentric and comparative study: catheterization versus
echocardiography.
60 patients referred for coronary angiography will be recruited consecutively during their
hospitalization.
Patients should perform a low intensity and short duration exercise, in both catheterization
and echo labs (pedaling 3 minutes at 25Watts then, 3 minutes at 50W) The LVEDP will be
measured invasively with a pigtail, at rest and at both levels of exercise.
Echocardiography will be performed within 24 hours after catheterization, after a full
examination at rest, an identical exercise (same intensity, same duration, same position of
the patient) than made in catheterization lab will be done. Following parameters will be
recorded at both stress levels: trans mitral flow, mitral annular pulsed tissue Doppler
imaging (both lateral and septal) and tricuspid regurgitation flow.
The doctor who will perform the echocardiographic acquisitions will not be informed of the
results of catheterization. The acquisitions will be analyzed in a second time still blinded
to the catheterization data.
The following echocardiographic parameters will be collected and compared to the invasive
measurement of LVEDP:
- Ratio between pulsed Doppler peak E velocity and peak Ea velocity obtained with tissue
Doppler imaging (E/Ea ratio) at rest and exercise,
- maximal LA volume indexed to body area
- (maximal LA volume) to (maximal LV volume) ratio.
- LA distensibility defined by: (maximal LA volume - minimal LA volume) / (minimal LA
volume)
- LA Global longitudinal strain Finally, it will be investigated whether the combined use
of E/Ea ratio at exercise with LA remodeling indices (of morphology and/or function)
improves the performance characteristics of diagnostic test, compared to a separate use
of these parameters.
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Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Diagnostic
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