Patients with HFNEF achieved similar peak exercise PCWP to controls but at a lower work rate, resulting in a significantly higher peak PCWP/work rate ratio (46 vs 20 mm Hg/W/kg; p=0.03).
Case-Control (n=22)
Does the E/e' ratio reflect hemodynamic changes during exercise in patients with heart failure with normal ejection fraction?
In patients with HFNEF, the E/e' ratio does not accurately reflect the hemodynamic changes that occur during exercise, despite these patients exhibiting abnormal hemodynamics such as lower stroke volume index and higher systemic vascular resistance.
Absolute Event Rate: 46% vs 20%
p-value: p=0.03
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. (J Am Coll Cardiol 2010;56:855-63) Original language English Pages (from-to) 855-863 Number of pages 9 Journal Journal of the American College of Cardiology Volume 56 Issue number 11 DOIs https://doi.org/10.1016/j.jacc.2010.04.040 Publication status Published - 7 Sept 2010 Keywords echocardiography ejection fraction exercise heart failure hemodynamics
Maeder et al. (2010) conducted a case-control in Heart failure with normal ejection fraction (HFNEF) (n=22). Heart failure with normal ejection fraction vs. Asymptomatic controls was evaluated on Peak PCWP/work rate ratio (p=0.03). Patients with HFNEF achieved similar peak exercise PCWP to controls but at a lower work rate, resulting in a significantly higher peak PCWP/work rate ratio (46 vs 20 mm Hg/W/kg; p=0.03).