CENTRAL ILLUSTRATION.

Dyspnea on Exertion Is the Most Common Symptom in HFpEF and Is Due in Part to Elevation of LA Pressure During Exertion

Some patients have normal left atrial (LA) pressure at rest, but have exercise-induced left atrial hypertension (EILAH). Compared to those with resting left atrial hypertension (RELAH), the group with EILAH had fewer comorbidities, lower natriuretic peptide levels, less cardiac remodeling, and better 6-minute walk distance (6MWD). They were more likely to have characteristics associated with favorable response to atrial shunt therapy (lower exercise pulmonary vascular resistance [PVR] and fewer implanted pacemakers). Hemodynamics at rest and with exertion suggest that patients with EILAH may have less left-to-right shunting at rest, but equivalent shunting (LA decompression) during exercise. BNP = B-type natriuretic peptide; DOE = dyspnea on exertion; HFpEF = heart failure with preserved ejection fraction; KCCQ = Kansas City Cardiomyopathy Questionnaire; LV = left ventricle.