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Echocardiographic predictors of exercise intolerance in patients with heart failure with severely reduced ejection fraction
Decreased exercise capacity (EC) is an established predictor of cardiac and all-cause mortality in patients with chronic heart failure (HF). No correlation has been found between EC and left ventricular (LV) ejection fraction. Moreover, data about the effect of right ventricular (RV) function on EC...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6076165/ https://www.ncbi.nlm.nih.gov/pubmed/29995821 http://dx.doi.org/10.1097/MD.0000000000011523 |
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author | Zaborska, Beata Smarż, Krzysztof Makowska, Ewa Czepiel, Aleksandra Świątkowski, Maciej Jaxa-Chamiec, Tomasz Budaj, Andrzej |
author_facet | Zaborska, Beata Smarż, Krzysztof Makowska, Ewa Czepiel, Aleksandra Świątkowski, Maciej Jaxa-Chamiec, Tomasz Budaj, Andrzej |
author_sort | Zaborska, Beata |
collection | PubMed |
description | Decreased exercise capacity (EC) is an established predictor of cardiac and all-cause mortality in patients with chronic heart failure (HF). No correlation has been found between EC and left ventricular (LV) ejection fraction. Moreover, data about the effect of right ventricular (RV) function on EC in HF with severe LV dysfunction are limited and contradictory. In this study, we aimed to investigate the relationship between EC and myocardial mechanics in patients with HF with reduced ejection fraction. Consecutive patients with symptomatic HF and LV ejection fraction ≤35% were prospectively assessed. All patients were evaluated with enhanced echocardiography. A symptom-limited treadmill cardiopulmonary exercise test (CPX) was performed within 24-hour interval. Patients were stratified into 4 groups according to their EC defined by Weber's classification. Prognosis of EC, expressed as oxygen uptake at peak exercise (peak VO(2)), was evaluated in multivariate linear regression analysis model. Sixty-seven patients with New York Heart Association classes II to III and a mean LV ejection fraction of 26 ± 7% were enrolled. A wide range of peak VO(2) was observed in CPX with patient exercise performance distributed to all classes according to Weber's classification. Significant differences were found in RV systolic and diastolic functions between groups with different classes of EC: RV peak systolic myocardial velocity (S′) (P < .001), tricuspid annular plane systolic excursion (TAPSE) (P = .003), RV E’ (P = .003). In patients with functional decline, systolic pulmonary artery pressure (PASP) was higher (P = .029) and TAPSE/PASP ratio was lower (P = .006). No significant differences were found in LV diameter, systolic and diastolic function, and degree of mitral regurgitation. Thirty three patients with RV systolic dysfunction showed lower peak VO(2) and oxygen uptake at anaerobic threshold (P = .008, P = .006, respectively), shorter exercise time (P = .003), and lower systolic blood pressure (P = .01) than in patients with normal RV systolic function. Logistic multivariate linear regression analysis with stepwise inclusion and exclusion revealed that gender, RV S′, and RV free wall strain were independent predictors of peak VO(2). RV function, assessed as S′ and free wall strain, was independently related to EC, measured using CPX, in patients with HF and severe LV systolic dysfunction. |
format | Online Article Text |
id | pubmed-6076165 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-60761652018-08-17 Echocardiographic predictors of exercise intolerance in patients with heart failure with severely reduced ejection fraction Zaborska, Beata Smarż, Krzysztof Makowska, Ewa Czepiel, Aleksandra Świątkowski, Maciej Jaxa-Chamiec, Tomasz Budaj, Andrzej Medicine (Baltimore) Research Article Decreased exercise capacity (EC) is an established predictor of cardiac and all-cause mortality in patients with chronic heart failure (HF). No correlation has been found between EC and left ventricular (LV) ejection fraction. Moreover, data about the effect of right ventricular (RV) function on EC in HF with severe LV dysfunction are limited and contradictory. In this study, we aimed to investigate the relationship between EC and myocardial mechanics in patients with HF with reduced ejection fraction. Consecutive patients with symptomatic HF and LV ejection fraction ≤35% were prospectively assessed. All patients were evaluated with enhanced echocardiography. A symptom-limited treadmill cardiopulmonary exercise test (CPX) was performed within 24-hour interval. Patients were stratified into 4 groups according to their EC defined by Weber's classification. Prognosis of EC, expressed as oxygen uptake at peak exercise (peak VO(2)), was evaluated in multivariate linear regression analysis model. Sixty-seven patients with New York Heart Association classes II to III and a mean LV ejection fraction of 26 ± 7% were enrolled. A wide range of peak VO(2) was observed in CPX with patient exercise performance distributed to all classes according to Weber's classification. Significant differences were found in RV systolic and diastolic functions between groups with different classes of EC: RV peak systolic myocardial velocity (S′) (P < .001), tricuspid annular plane systolic excursion (TAPSE) (P = .003), RV E’ (P = .003). In patients with functional decline, systolic pulmonary artery pressure (PASP) was higher (P = .029) and TAPSE/PASP ratio was lower (P = .006). No significant differences were found in LV diameter, systolic and diastolic function, and degree of mitral regurgitation. Thirty three patients with RV systolic dysfunction showed lower peak VO(2) and oxygen uptake at anaerobic threshold (P = .008, P = .006, respectively), shorter exercise time (P = .003), and lower systolic blood pressure (P = .01) than in patients with normal RV systolic function. Logistic multivariate linear regression analysis with stepwise inclusion and exclusion revealed that gender, RV S′, and RV free wall strain were independent predictors of peak VO(2). RV function, assessed as S′ and free wall strain, was independently related to EC, measured using CPX, in patients with HF and severe LV systolic dysfunction. Wolters Kluwer Health 2018-07-13 /pmc/articles/PMC6076165/ /pubmed/29995821 http://dx.doi.org/10.1097/MD.0000000000011523 Text en Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 |
spellingShingle | Research Article Zaborska, Beata Smarż, Krzysztof Makowska, Ewa Czepiel, Aleksandra Świątkowski, Maciej Jaxa-Chamiec, Tomasz Budaj, Andrzej Echocardiographic predictors of exercise intolerance in patients with heart failure with severely reduced ejection fraction |
title | Echocardiographic predictors of exercise intolerance in patients with heart failure with severely reduced ejection fraction |
title_full | Echocardiographic predictors of exercise intolerance in patients with heart failure with severely reduced ejection fraction |
title_fullStr | Echocardiographic predictors of exercise intolerance in patients with heart failure with severely reduced ejection fraction |
title_full_unstemmed | Echocardiographic predictors of exercise intolerance in patients with heart failure with severely reduced ejection fraction |
title_short | Echocardiographic predictors of exercise intolerance in patients with heart failure with severely reduced ejection fraction |
title_sort | echocardiographic predictors of exercise intolerance in patients with heart failure with severely reduced ejection fraction |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6076165/ https://www.ncbi.nlm.nih.gov/pubmed/29995821 http://dx.doi.org/10.1097/MD.0000000000011523 |
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