Supine is Divine.pptx

1、Supine Is Divine:Hemodynamic Exercise Testing Assessments Should Be in the Supine Position,Barry A.Borlaug,MDMayo Clinic,borlaug.barrymayo.edu,Disclosure,Financial RelationshipsResearch Support:NIH/NHLBI,DoD,Axon,AstraZeneca,Corvia,Medtronic,Novo Nordisk,Rivus,Tenax TherapeuticsConsulting/Advisory B

2、oard:Actelion,Amgen,Aria,Boehringer Ingelheim,Edwards Lifesciences,Eli Lilly,Imbria,Janssen,Merck,Novo Nordisk,NGMBio,ShouTi,VADovations Off-Label/Investigational Uses None,70 yo woman with dyspnea,normal NT-proBNP,H2FPEF score 4,Some argue that this test should have been upright,Reasons cited for b

3、y Upright Enthusiasts,Upright is more“physiological”Upright exercise testing may have greater specificityUpright is more likely to reveal“preload failure”,Patients with HFpEF are symptomatic in all positions.in fact,dyspnea is characteristically is worse supine(orthopnea,PND)or with squatting(bendop

4、nea).The absence of these symptoms upright does not prove that such patients do not have HF,“Physiology”applies to all body positions,Fudim.Caravita Circ Heart Fail 2024,*,Are you really saying these patientsdo NOT have HF?,Does the absence of upright PCWP exclude HFpEF?,Zile,Baicu,Gaasch New Engl J

5、 Med 2004,Thadani&Parker Am J Cardiol 1978,Is supine exercise less sensitive to detect“preload failure”?,Almost certainly:filling pressures&venous return are lower upright,but(1)HFpEF is fundamentally characterized by an inability to accommodate venous return without PCWP elevation,we want more veno

6、us return to maximize sensitivity(2)Are we willing to sacrifice sensitivity to detect HFpEF in order to improve sensitivity for“preload failure”?,Upright testing is nontrivial for our patients&labs,Distance from tipto HIP:10 cm blood=7.4 mmHg,Right atriumat level of tricuspid val