Heart Failure with Preserved Ejection Fraction (HFpEF) and Pulmonary Hypertension (PH) can be diagnosed noninvasively by Exercise Echocardiography (ExE) and Cardiopulmonary Exercise Testing (CPX) as compared with gold standard invasive hemodynamic assessment.

• The broad objective of this proposal is to characterize the dynamic changes in cardiopulmonary mechanics during stress in patients with exertional dyspnea, establishing a comprehensive multimodality diagnostic approach to the evaluation of exercise intolerance.
• The specific objective is to prospectively compare established and novel parameters derived from echocardiography and CPX with simultaneous, gold standard invasive measures of cardiovascular hemodynamics at rest and with exercise stress to define the role of noninvasive testing in the diagnostic workup.
• The primary hypothesis is that combined ExE and CPX can noninvasively identify HFpEF.

Inclusion Criteria:

• exertional intolerance/dyspnea of unknown etiology
• referral to cardiac catheterization laboratory
• undergoing invasive hemodynamic evaluation for clinical purposes

Exclusion Criteria:

• hypertrophic cardiomyopathy
• constrictive pericarditis
• infiltrative myopathy (e.g. amyloid)
• congenital heart disease
• resting LVEF <50%
• > moderate mitral annular calcification
• moderate or greater left-sided valvular stenosis or regurgitation
• prior valve surgery
• basal septal wall motion abnormalities
• >70% epicardial coronary artery stenosis
• right ventricular infarction
• pregnancy

Cardiac Catheterization Laboratory