Feasibility of Exercise Hemodynamic Evaluation in the Clinical Cardiac Catheterization Laboratory

Purpose Provocative testing during right heart catheterization (RHC) is gaining increasing acceptance to evaluate cardiac and pulmonary vascular contributions to dyspnea. For this purpose, the use of cycle ergometry at measured work rates has been recommended as a physiologically relevant and sensitive stressor. Methods The program was initiated in 07/2016. After standard diagnostic RHC, patients were transferred to a cycle ergometer and hemodynamics were assessed in up to 2 exercise stages if tolerated. Hemodynamic diagnoses at rest were assigned based on guideline recommendations and exercise hemodynamic diagnoses were assigned based on sex-specific reference ranges developed by our laboratory. Results Between 07/2016 and 09/2018, 77 patients (60 ± 14 years, 48% female) were referred. Resting hemodynamic assessment was performed in all patients and the exercise protocol was initiated in 74. Figure 1 illustrates the hemodynamic classification at rest and after the exercise protocol. At rest, 47 patients (61%) had normal hemodynamics; after the exercise protocol, the number of patients with normal hemodynamics declined to 26 (34%). Exercise induced pulmonary hypertension related to left heart disease (PH-LHD) was disclosed in 18 (38%) of 47 patients with normal resting hemodynamics. One year follow-up (FUP) assessment has been completed in 19 patients and death or hospitalization was observed in 4 (21%) patients that had 1 year FUP assessment completed and all these adverse outcomes occurred amongst patients with abnormal hemodynamic findings during exercise. Conclusion In this prospective series, a submaximal, cycle ergometry protocol performed during RHC was possible in 96% of the cohort referred. The intervention revealed hemodynamic abnormalities in 45% of patients with normal resting hemodynamics. Amongst patients with normal hemodynamic findings during exercise that had 1 year FUP assessment completed, none had an adverse composite outcome of death or hospitalization.