ArticleChest2023
Reducing Pulmonary Capillary Wedge Pressure During Exercise Exacerbates Exertional Dyspnea in Patients With Heart Failure With Preserved Ejection Fraction: Implications for V˙/Q˙ Mismatch.
Article in Chest, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
12 citing papers in PubMed, 16 citations in OpenAlex.
- Ventilatory limitation to exercise in patients with HFpEF and obesity: No room to breathe.Respiratory physiology & neurobiology · 2026Trial
- Oxygen cost of breathing and its association with dyspnea in older patients with heart failure with preserved ejection fraction and obesity.Journal of applied physiology (Bethesda, Md. : 1985) · 2026Article
- Left ventricular transmural pressure and ventilatory inefficiency during exercise in advanced heart failure.ESC heart failure · 2026Article
- A non-linear pattern of exercise capacity in heart failure across ejection fraction categories.Scientific reports · 2026Article
- Pressure applied: Mechanisms affecting heart-lung interactions and cardiac filling in patients with HFpEF during rest and exercise.Heart failure reviews · 2025Review
- Exercise-induced arterial hypoxaemia in patients with heart failure with preserved ejection fraction.The Journal of physiology · 2025Article
- Mechanisms of exercise intolerance in heart failure with preserved ejection fraction (HFpEF).Heart failure reviews · 2025Review
- Determinants of cardiac output in health and heart failure.Experimental physiology · 2025Review
- Cardiac Fatigue in Male Athletes with Exercise-Induced Pulmonary Impairments After a Very Long-Distance Triathlon.Sports medicine (Auckland, N.Z.) · 2025Article
- Pulmonary gas exchange in relation to exercise pulmonary hypertension in patients with heart failure with preserved ejection fraction.The European respiratory journal · 2025Article
- Exercise Therapy Rescues Skeletal Muscle Dysfunction and Exercise Intolerance in Cardiometabolic HFpEF.JACC. Basic to translational science · 2024Article
- Respiratory symptom perception during exercise in patients with heart failure with preserved ejection fraction.Respiratory physiology & neurobiology · 2024Article
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundThe primary cause of dyspnea on exertion in heart failure with preserved ejection fraction (HFpEF) is presumed to be the marked rise in pulmonary capillary wedge pressure during exercise; however, this hypothesis has never been tested directly. Therefore, we evaluated invasive exercise hemodynamics and dyspnea on exertion in patients with HFpEF before and after acute nitroglycerin (NTG) treatment to lower pulmonary capillary wedge pressure. RESEARCH QUESTION: Does reducing pulmonary capillary wedge pressure during exercise with NTG improve dyspnea on exertion in HFpEF? STUDY DESIGN AND
methodsThirty patients with HFpEF performed two invasive 6-min constant-load cycling tests (20 W): one with placebo (PLC) and one with NTG. Ratings of perceived breathlessness (0-10 scale), pulmonary capillary wedge pressure (right side of heart catheter), and arterial blood gases (radial artery catheter) were measured. Measurements of V˙/Q˙ matching, including alveolar dead space (Vd
resultsRatings of perceived breathlessness increased (PLC: 3.43 ± 1.94 vs NTG: 4.03 ± 2.18; P = .009) despite a clear decrease in pulmonary capillary wedge pressure at 20 W (PLC: 19.7 ± 8.2 vs NTG: 15.9 ± 7.4 mm Hg; P < .001). Moreover, Vd
interpretationThese findings have important clinical implications and indicate that lowering pulmonary capillary wedge pressure does not decrease dyspnea on exertion in patients with HFpEF; rather, lowering pulmonary capillary wedge pressure exacerbates dyspnea on exertion, increases V˙/Q˙ mismatch, and worsens ventilatory efficiency during exercise in these patients. This study provides compelling evidence that high pulmonary capillary wedge pressure is likely a secondary phenomenon rather than a primary cause of dyspnea on exertion in patients with HFpEF, and a new therapeutic paradigm is needed to improve symptoms of dyspnea on exertion in these patients.
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