Prevalence of occult HFpEF and age-specific efficacy of passive leg raise in pulmonary hypertension

Abstract

Background: Occult heart failure with preserved ejection fraction (HFpEF), characterized by elevated pulmonary arterial wedge pressure during exercise (PAWP_exercise), has gained attention in the context of pulmonary hypertension (PH). This study aimed to evaluate the prevalence of occult HFpEF and assess the diagnostic efficacy of passive leg raise (PLR) in patients with confirmed or suspected PH.

Methods: A total of 619 patients with normal resting PAWP underwent symptom-limited exercise testing using a supine cycle ergometer in conjunction with right heart catheterization (RHC) for PH diagnosis and treatment assessment. Occult HFpEF was defined as PAWP_exercise ≥ 25 mmHg. Receiver operating characteristic curves were constructed, and the area under the curve (AUC) was calculated to evaluate the diagnostic utility of PAWP_PLR for identifying occult HFpEF.

Results: Among the 619 patients (median age: 61 years, 78% female; median PAWP at rest: 8 mmHg), 80 (13%) demonstrated occult HFpEF. The prevalence was 7%, 21%, and 16% in patients aged < 60 years, 60-69 years, and ≥ 70 years, respectively. PAWP_PLR was significantly elevated in the occult HFpEF group compared to the non-HFpEF group across all age categories. The AUC values for detecting occult HFpEF using PAWP_PLR were 0.75 for patients < 60 years, 0.78 for those aged 60-69 years, and 0.79 for those ≥ 70 years, with respective cut-off values of 14, 13, and 13 mmHg.

Conclusions: Occult HFpEF is prevalent among patients with PH. PAWP_PLR serves as a valuable, non-invasive tool, necessitating age-specific thresholds to enhance diagnostic accuracy.

Keywords: Hemodynamics; Occult heart failure with preserved ejection fraction; Passive leg raise; Pulmonary arterial wedge pressure; Pulmonary hypertension.