An elevated peak pulmonary vascular resistance (PVR) is associated with a high risk of heart failure (HF)-related hospitalization in patients with exercise-induced heart failure with preserved ejection fraction (HFpEF), a recent study found. The study evaluated the long-term prognostic implications of PV-dysfunction in HFpEF during exercise in consecutive patients undergoing invasive cardiopulmonary exercise testing for unexplained dyspnea. Patients with HFpEF were classified into 2 main groups: resting-HFpEF (n=104) with a pulmonary artery wedge pressure (PWAP) >15 mm Hg at rest; and exercise-HFpEF (n=81) with a PAWP <15 mHg at rest, but >20 mmHg during exercise. Outcomes were analyzed for the first 9 years of follow-up and included any cause mortality and HF-related hospitalizations. Researchers found:

• Mortality rate did not differ among the groups.
• However, survival free of HF-related hospitalization was lower for the exercise-HFpEF+dysfunction group vs to the exercise-HFpEF-PV dysfunction.
• Findings were similar between exercise-HFpEF+PV-dysfunction and the resting-HFpEF group.
• Peak PVR ≥80 dynes.s.cm^-5 was a predictor of HF–related hospitalization for exercise-HFpEF (HR 5.73).