{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:31:34Z","timestamp":1790663494931,"version":"4.1.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Invasive exercise right heart catheterization is a gold standard in diagnosing heart failure with preserved ejection fraction (HFpEF). Body positions during the test influence hemodynamics. However, the discrepancy in HFpEF diagnosis between exercise testing in supine versus upright position is unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>We conducted a 2-center prospective study enrolling patients referred for exercise right heart catheterization for HFpEF. We performed a Supright protocol integrating submaximal supine bicycle ergometry (20 W) followed by maximal upright bicycle ergometry with a breath-by-breath oxygen analyzer. HFpEF hemodynamic criteria specific to testing positions were applied. Patients were considered to have concordant HFpEF if they met criteria in both positions or discordant HFpEF if they met criteria only in the supine position.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Of 36 patients who met HFpEF criteria in supine position, 18 (50%) did not meet criteria in upright position (discordant HFpEF). Discordant HFpEF had less atrial fibrillation (0% versus 55%;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001), lower left atrial volume (60\u00b114 versus 77\u00b121 mL;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.010), and lower H\n              <jats:sub>2<\/jats:sub>\n              FPEF score (2.1\u00b11.3 versus 5.1\u00b12.3;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001). In supine position, pulmonary arterial wedge pressure was lower in discordant HFpEF at rest (15\u00b14 versus 19\u00b17 mm\u2005Hg;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.040). In upright position, pulmonary arterial wedge pressure was lower in discordant HFpEF both at rest (8\u00b14 versus 14\u00b16 mm\u2005Hg;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.002) and at peak exercise (14\u00b14 versus 27\u00b17 mm\u2005Hg;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001). Pulmonary arterial wedge pressure\/cardiac output slope was lower in discordant HFpEF (1.6\u00b11.7 versus 3.6\u00b12.9;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001). Maximal workload (46\u00b118 versus 49\u00b124 W;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.59) or peak oxygen consumption (11.4\u00b12.8 versus 12.9\u00b13.4 mL\/[kg\u00b7min];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.15) was similar between groups.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Half of patients who met HFpEF criteria in the supine position did not meet the criteria in the upright position. Patients with a discordant HFpEF phenotype had less structural and hemodynamic abnormalities compared with those with concordant HFpEF. A Supright exercise right heart catheterization approach is feasible and merits further investigation to determine the clinical implications of discordant exercise hemodynamic findings in supine and upright positions.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.124.012020","type":"journal-article","created":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T10:02:34Z","timestamp":1731060154000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["Discrepancy in the Diagnosis of Heart Failure With Preserved Ejection Fraction Between Supine Versus Upright Exercise Hemodynamic Testing"],"prefix":"10.1161","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8671-7007","authenticated-orcid":true,"given":"Marat","family":"Fudim","sequence":"first","affiliation":[{"name":"Department of Medicine (M.F., V.K., A.S., A.G., J. Mikitka, E.Y., O.D., M.R., J.F., J. Molinger, B.P.), Duke University Medical Center, Durham, NC."},{"name":"Duke Clinical Research Institute, Durham, NC (M.F., V.K.)."},{"name":"Institute of Heart Diseases, Wroclaw Medical University, Poland (M.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veraprapas","family":"Kittipibul","sequence":"additional","affiliation":[{"name":"Department of Medicine (M.F., V.K., A.S., A.G., J. Mikitka, E.Y., O.D., M.R., J.F., J. Molinger, B.P.), Duke University Medical Center, Durham, NC."},{"name":"Duke Clinical Research Institute, Durham, NC (M.F., V.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Swavely","sequence":"additional","affiliation":[{"name":"Department of Medicine (M.F., V.K., A.S., A.G., J. Mikitka, E.Y., O.D., M.R., J.F., J. Molinger, B.P.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Gray","sequence":"additional","affiliation":[{"name":"Department of Medicine (M.F., V.K., A.S., A.G., J. Mikitka, E.Y., O.D., M.R., J.F., J. Molinger, B.P.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Mikitka","sequence":"additional","affiliation":[{"name":"Department of Medicine (M.F., V.K., A.S., A.G., J. Mikitka, E.Y., O.D., M.R., J.F., J. Molinger, B.P.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Medicine (M.F., V.K., A.S., A.G., J. Mikitka, E.Y., O.D., M.R., J.F., J. Molinger, B.P.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Dobbin","sequence":"additional","affiliation":[{"name":"Department of Medicine (M.F., V.K., A.S., A.G., J. Mikitka, E.Y., O.D., M.R., J.F., J. Molinger, B.P.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Radzom","sequence":"additional","affiliation":[{"name":"Department of Medicine (M.F., V.K., A.S., A.G., J. Mikitka, E.Y., O.D., M.R., J.F., J. Molinger, B.P.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1020-6932","authenticated-orcid":true,"given":"Jacqueline","family":"Fee","sequence":"additional","affiliation":[{"name":"Department of Medicine (M.F., V.K., A.S., A.G., J. Mikitka, E.Y., O.D., M.R., J.F., J. Molinger, B.P.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0608-3305","authenticated-orcid":true,"given":"Jeroen","family":"Molinger","sequence":"additional","affiliation":[{"name":"Department of Medicine (M.F., V.K., A.S., A.G., J. Mikitka, E.Y., O.D., M.R., J.F., J. Molinger, B.P.), Duke University Medical Center, Durham, NC."},{"name":"Department of Anesthesiology (J. Molinger), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandy","family":"Patterson","sequence":"additional","affiliation":[{"name":"Department of Medicine (M.F., V.K., A.S., A.G., J. Mikitka, E.Y., O.D., M.R., J.F., J. Molinger, B.P.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8735-7851","authenticated-orcid":true,"given":"Giovanni","family":"Battista Perego","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ospedale San Luca Istituto di Ricerca e Cura a Carattere Scientifico, Istituto Auxologico Italiano, Milan, Italy (G.B.P., L.P.B., G.P., C.B., S.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0379-3283","authenticated-orcid":true,"given":"Luigi P.","family":"Badano","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ospedale San Luca Istituto di Ricerca e Cura a Carattere Scientifico, Istituto Auxologico Italiano, Milan, Italy (G.B.P., L.P.B., G.P., C.B., S.C.)."},{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, Italy (L.P.B., G.P., M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9402-7439","authenticated-orcid":true,"given":"Gianfranco","family":"Parati","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ospedale San Luca Istituto di Ricerca e Cura a Carattere Scientifico, Istituto Auxologico Italiano, Milan, Italy (G.B.P., L.P.B., G.P., C.B., S.C.)."},{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, Italy (L.P.B., G.P., M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6358-7852","authenticated-orcid":true,"given":"Jean-Luc","family":"Vachi\u00e9ry","sequence":"additional","affiliation":[{"name":"Department of Cardiology, H\u00f4pital Universitaire de Bruxelles, H\u00f4pital Erasme, Universit\u00e9 Libre de Bruxelles, Belgium (J.-L.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5502-7882","authenticated-orcid":true,"given":"Michele","family":"Senni","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, Italy (L.P.B., G.P., M.S.)."},{"name":"Cardiovascular Department, Azienda Socio Sanitaria Territoriale, Papa Giovanni XXIII, Bergamo, Italy (M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8816-9086","authenticated-orcid":true,"given":"Ettore","family":"Lanzarone","sequence":"additional","affiliation":[{"name":"Department of Management, Information, and Production Engineering, University of Bergamo, Dalmine BG, Italy (E.L., F.P., S.P., S.C., 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