Left ventricular transmural pressure and ventilatory inefficiency during exercise in advanced heart failure

Background

Baseline intracavitary haemodynamic measurements frequently demonstrate an inconsistent relationship with exertional performance. This may reflect an incomplete interpretation of left ventricular (LV) filling pressures. LV transmural pressure difference (ΔPTM = LV end-diastolic pressure [LVEDP]-right atrial pressure [RAP]) integrates LV filling pressure with right ventricular/pericardial constraint and may provide a composite representation of resting haemodynamic conditions. Ventilatory efficiency, assessed by the minute ventilation-carbon dioxide production (VE/VCO2) slope during cardiopulmonary exercise testing (CPET), is a leading representation of cardiopulmonary reserves and a powerful prognostic marker in heart failure (HF). Whether ΔPTM is associated with exercise ventilatory efficiency beyond conventional resting filling pressure measurements remains unclear.