May 1, 2010
View Full PaperCardiopulmonary Exercise Testing Variables Reflect the Degree of Diastolic Dysfunction in Patients With Heart Failure–Normal Ejection Fraction
Structured PICO
Do cardiopulmonary exercise testing variables correlate with echocardiographic markers of diastolic dysfunction in patients with heart failure and normal ejection fraction?
P
Population
32 patients with heart failure and normal ejection fraction (HF-NEF)
I
Intervention
Cardiopulmonary exercise testing (CPX) and echocardiography with tissue Doppler imaging (TDI)
O
Outcome
Correlation between echocardiographic variables (E/E', ejection fraction, LV mass, LV end systolic volume) and CPX variables (peak VO2, ventilatory efficiency, PETCO2, HRR1)surrogate
Cardiopulmonary exercise testing variables, particularly peak oxygen uptake, ventilatory efficiency, and heart rate recovery, correlate significantly with E/E' in patients with HF-NEF, suggesting CPX provides valuable insight into diastolic dysfunction.
Abstract
PURPOSE: Previous investigations have reported a relationship between variables obtained from echocardiography with tissue Doppler imaging (TDI) and cardiopulmonary exercise testing (CPX) in systolic heart failure (HF) cohorts. The purpose of the present investigation was to perform a comparative analysis between echocardiography with TDI and CPX in patients with HF and normal ejection fraction (NEF). METHODS: Patients with HF-NEF (N = 32) underwent echocardiography with TDI and CPX to determine the following variables: (1) the ratio between mitral early velocity (E) and mitral annular velocity (E'), (2) ejection fraction, (3) left ventricular (LV) mass, (4) left ventricular end systolic volume, (5) peak oxygen uptake (.VO2), (6) ventilatory efficiency, (7) the partial pressure of end-tidal carbon dioxide (P(ET)CO2) at rest and peak exercise, and (8) heart rate recovery at 1 minute (HRR1). RESULTS: Pearson correlation revealed that E/E' was significantly correlated with peak oxygen uptake (r = -0.55, P = .001), the ventilatory efficiency slope (r = 0.60, P 10 (positive likelihood ratio: 13:2). DISCUSSION: E/E' provides an accurate reflection of LV filling pressure and thus, insight into diastolic function. The results of the present investigation indicate CPX provides insight into cardiac dysfunction in patients with HF-NEF and thus, may eventually prove to be a valuable and accepted clinical assessment.