First-in-Human Experience of Mechanical Preload Control in Patients With HFpEF During Exercise

Daniel W Kaiser; Patrick Platzer; Katie Miyashiro; James Canfield; Rupal Patel; Dandan Liu; Frederick St Goar; Clayton A Kaiser

doi:10.1016/j.jacbts.2020.12.007

First-in-Human Experience of Mechanical Preload Control in Patients With HFpEF During Exercise

JACC Basic Transl Sci. 2021 Feb 17;6(3):189-198. doi: 10.1016/j.jacbts.2020.12.007. eCollection 2021 Mar.

Authors

Daniel W Kaiser^{1

2

3}, Patrick Platzer², Katie Miyashiro³, James Canfield¹, Rupal Patel¹, Dandan Liu⁴, Frederick St Goar¹, Clayton A Kaiser^{2

3}

Affiliations

¹ Department of Respiratory Therapy, El Camino Hospital, Mountain View, California.
² Department of Cardiovascular Medicine, Saint Thomas Hospital, Nashville, Tennessee, USA.
³ CardioFlow Technologies, Nashville, Tennessee, USA.
⁴ Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Abstract

Exercise intolerance remains one of the major factors determining quality of life in heart failure patients. In 6 patients with heart failure with preserved ejection fraction (HFpEF) undergoing invasive cardiopulmonary exercise testing, balloon inflation within the inferior vena cava (IVC) was performed during exercise to reduce and maintain pulmonary arterial (PA) pressures. Partial IVC occlusion significantly reduced PA pressures without reducing cardiac output. Partial IVC occlusion significantly reduced respiratory rate at matched levels of exercise. These findings highlight the importance of pulmonary pressures in the pathophysiology of HFpEF and suggest that therapies targeting hemodynamics may improve symptoms and exercise capacity in these patients.

Keywords: CPET, cardiopulmonary exercise testing; HFpEF, heart failure with preserved ejection fraction; IVC occlusion; IVC, inferior vena cava; LV, left ventricle/ventricular; PA, pulmonary artery; PCWP, pulmonary capillary wedge pressure; VCO2, carbon dioxide consumption; VO2, oxygen consumption; cardiac output; heart failure; hemodynamics.