Letter by Wussler et al Regarding Article, Challenging the Hemodynamic Hypothesis in Heart Failure With Preserved Ejection Fraction: Is Exercise Capacity Limited by Elevated Pulmonary Capillary Wedge Pressure?

Summary: Exercise intolerance is a common symptom in patients with heart failure with preserved ejection fraction (HFpEF), which is believed to be caused by a marked rise in pulmonary capillary wedge pressure (PCWP). This study investigated the effect of nitroglycerin on PCWP and exercise capacity in patients with HFpEF. The results showed that nitroglycerin successfully reduced PCWP during exercise, but did not improve peak oxygen uptake. These findings suggest that reducing PCWP alone is not sufficient to enhance exercise capacity in patients with HFpEF.

Summary: Reduced exercise capacity in atrial fibrillation (AF) patients is associated with elevated left ventricular filling pressure and reduced chronotropic response rather than rhythm status. Subjectively reported exercise intolerance is not a sensitive assessment of reduced exercise capacity.