Author + information
- Cory Tranklea,b,
- Justin Canadaa,b,
- Leo Buckleya,b,
- Salvatore Carbonea,b,
- Dave Dixona,b,
- Ross Arenaa,b,
- Benjamin Van Tassella,b and
- Antonio Abbatea,b
Background: Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by impaired cardiac function, resulting in exertion-limiting shortness of breath and fatigue. Assessing diastolic Doppler echocardiographic parameters, including transmitral diastolic inflow velocities (E and A waves) and early diastolic mitral annular velocity (E’) may provide insight into the pathophysiology of exercise intolerance in HFpEF. However, diagnostic utility may be limited if they are completed only at rest.
Methods: We selected 16 subjects with stable symptomatic HFpEF who showed impaired functional capacity by cardiopulmonary exercise testing and measured peak oxygen consumption (VO2). We measured peak E and A velocities, E/A ratio, E wave deceleration time, E’ velocity and E/E’ ratio at rest and at peak exercise. The diastolic functional reserve index (DFRI) was calculated as the product of E’ at rest and the interval change in E’ with exercise.
Results: Twelve (75%) were women; median age was 55 (51-60) years. Exercise duration was 8.5 (6.6-10.6) min with a peak VO2 of 14.0 (12.0-18.7) mL*kg-1*min-1. E’ velocity at peak exercise was positively correlated with exercise time (R=+0.63, p=0.010) and peak VO2 (R=0+0.63, p=0.004); DFRI had a similarly positive correlation with those two functional measurements (R=+0.49, p=0.056 and R=+0.58, p=0.020, respectively). On the other hand, exercise E/E’ was inversely correlated with exercise time (R=-0.51, p=0.042) and peak VO2 (R=-0.45, p=0.079). E/A ratio and E wave deceleration time modestly correlated with peak VO2. Exercise E’ was the only independent predictor of peak VO2 at multivariable analysis (R=+0.67, p=0.005).
Conclusions: The E’ velocity at peak exercise is a strong and independent predictor of aerobic exercise capacity as measured by peak VO2 in patients with HFpEF, providing the link between abnormal myocardial relaxation with exercise and impaired aerobic exercise capacity in HFpEF.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Emerging Developments in HFpEF and Arryhthmias
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1250-276
- 2017 American College of Cardiology Foundation