Author + information
- Received January 25, 2010
- Revision received March 25, 2010
- Accepted April 12, 2010
- Published online September 7, 2010.
- Micha T. Maeder, MD⁎,†,
- Bruce R. Thompson, PhD‡,
- Hans-Peter Brunner-La Rocca, MD§ and
- David M. Kaye, MD, PhD⁎,†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. David M. Kaye, Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, P.O. Box 6492, St. Kilda Road Central, Melbourne 8008, Victoria, Australia
Objectives The purpose of this study was to invasively investigate the hemodynamic response to exercise in patients with heart failure with normal ejection fraction (HFNEF) and to evaluate the ability of the peak early diastolic transmitral velocity to peak early diastolic annular velocity ratio (E/e′) to reflect exercise hemodynamics.
Background There is little information regarding the hemodynamic response to exercise in HFNEF.
Methods Patients with HFNEF (n = 14) and asymptomatic controls (n = 8) underwent right-side heart catheterization at rest and during supine cycle ergometer exercise and echocardiography with measurement of resting and peak exercise E/e′.
Results Resting pulmonary capillary wedge pressure (PCWP) (10 ± 4 mm Hg vs. 10 ± 4 mm Hg; p = 0.94) was similar in HFNEF patients and controls, but stroke volume index (SVI) (p = 0.02) was lower, and systemic vascular resistance index (SVRI) (p = 0.01) was higher in patients. Patients stopped exercise at lower work rate (0.63 ± 0.29 W/kg vs. 1.13 ± 0.49 W/kg; p = 0.006). Although peak exercise PCWP was similar in both groups (23 ± 6 mm Hg vs. 20 ± 7 mm Hg; p = 0.31), the peak PCWP/work rate ratio was higher in patients compared with controls (46 ± 31 mm Hg/W/kg vs. 20 ± 9 mm Hg/W/kg; p = 0.03). Peak exercise SVI (p = 0.001) was lower and SVRI was higher (p = 0.01) in patients. Resting E/e′ was modestly elevated in patients (13.2 ± 4.1 vs. 9.5 ± 3.4; p = 0.04). Peak exercise E/e′ did not differ between the groups (11.1 ± 3.4 vs. 9.4 ± 3.4; p = 0.28).
Conclusions The HFNEF patients achieved a similar peak exercise PCWP to that of asymptomatic controls, at a much lower workload. This occurs at a lower SVI and in the setting of higher SVRI. The E/e′ does not reflect the hemodynamic changes during exercise in HFNEF patients.
This study was supported by a Program Grant (to Dr. Kaye) from the National Health and Medical Research Council of Australia, Canberra, Australia, and the Swiss National Science Foundation, Berne, Switzerland, Grant PBZHB-121007(to Dr. Maeder). All other authors have reported that they have no relationships to disclose.
- Received January 25, 2010.
- Revision received March 25, 2010.
- Accepted April 12, 2010.
- American College of Cardiology Foundation