Author + information
- Leo F. Buckleya,b,
- Salvatore Carbonea,b,
- Justin Canadaa,b,
- Cory Tranklea,b,
- Sanah Christophera,b,
- Jessica Regana,b,
- Michele Mattia Viscusia,b,
- Dave L. Dixona,b,
- Nayef Abouzakia,b,
- Dinesh Kadariyaa,b,
- Ross Arenaa,b,
- Antonio Abbatea,b and
- Benjamin Van Tassella,b
Background: Ventilatory inefficiency, occurring to due ventilation/perfusion mismatch, independently predicts outcomes in systolic heart failure (SHF). However, the mechanism underlying this association is not understood. Increased afterload shifts the pressure-volume relationship rightward and impairs cardiac function during exercise. We hypothesize that increased arterial elastance (Ea), an afterload surrogate, correlates with worse ventilatory efficiency in patients with SHF.
Methods: Sixty SHF outpatients underwent noninvasive hemodynamic assessment (ccNexfin, Edwards Lifesciences) and maximal treadmill cardiopulmonary exercise testing. Ea was calculated as 0.9 × systolic blood pressure (SBP) divided by stroke volume. Minute ventilation-carbon dioxide production slope (VE/VCO2) and oxygen uptake efficiency slope (OUES) were captured.
Results: There were 43 (72%) men. Median (IQR) age, left ventricular ejection fraction and SBP were 57 (51-61) years, 32 (28-39) % and 118 (102-134) mm Hg, respectively. Ea was 1.66 (1.40-2.07) mm Hg/mL. Ea correlated significantly with worse VE/VCO2 slope and OUES (Figure). Notably, Ea significantly correlated with VE/VCO2 and OUES in patients with SBP above (VE/VCO2: R = 0.58, p = 0.003; OUES: R = −0.57, p = 0.003) and below (VE/VCO2: R = 0.36, p = 0.047; OUES: R = −0.39, p = 0.03) the median.
Conclusions: Arterial elastance, reflecting cardiac afterload, drives ventilatory inefficiency in SHF.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Making Progress in Understanding Heart Failure
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1123-291
- 2017 American College of Cardiology Foundation