Impaired myocardial relaxation with exercise determines peak aerobic exercise capacity in heart failure with preserved ejection fraction
Impaired myocardial relaxation with exercise determines peak aerobic exercise capacity in heart failure with preserved ejection fraction
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DOI：
10.1002/ehf2.12147
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发表时间：
2017-08-01
影响因子：
3.8
通讯作者：
Abbate, Antonio
中科院分区：
文献类型：
--
作者：
Trankle, Cory;Canada, Justin M.;Abbate, Antonio
背景 射血分数保留的心力衰竭（HFpEF）是一种临床综合征，其特征是由于呼吸短促和/或疲劳导致运动能力受损。休息和运动时舒张功能障碍的评估可能有助于深入了解 HFpEF 运动不耐受的病理生理学。目的 测量超声心动多普勒衍生的舒张功能参数，因为它们与 HFpEF 有氧运动能力的各种指标相关。方法我们选择了 16 名临床稳定 HFpEF 的受试者，没有容量超负荷的证据，但功能能力受损 心肺运动测试[峰值耗氧量（VO2）]。我们测量了经动脉 E 和 A 流速、E/A 比、E 减速时间 (DT) 和组织多普勒 E' 速度。我们还将 E' 与 DT 进行索引，作为放松受损的附加指标 (E'(DT))，并计算舒张功能储备指数 (DFRI)，即静息时 E' 与运动时 E' 变化的乘积。结果 E' 速度、静息时和峰值运动时以及 DFRI 与峰值摄氧量呈正相关，而 DT、E'(DT) 和 E/E' 则与峰值 VO2 呈正相关。 运动量与峰值摄氧量呈负相关。值得注意的是，静息时的 E'(DT) 也显着预测了运动峰值时的 E' 速度（R = +0.81，P < 0.001）。在多变量分析中，运动 E' 是峰值摄氧量的唯一独立预测因子（R = +0.67，P = 0.005）。 结论 根据 HFpEF 患者的峰值摄氧量测量，峰值运动时的 E' 速度是有氧运动能力的强有力且独立的预测因子，提供了运动引起的心肌松弛异常与 HFpEF 患者有氧运动能力受损之间的联系。
Background Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by impaired exercise capacity due to shortness of breath and/or fatigue. Assessment of diastolic dysfunction at rest and with exercise may provide insight into the pathophysiology of exercise intolerance in HFpEF.Aims To measure echocardio-Doppler-derived parameters of diastolic function as they relate to various indices of aerobic exercise capacity in HFpEF.Methods We selected 16 subjects with clinically stable HFpEF, no evidence of volume overload, but impaired functional capacity by cardiopulmonary exercise testing [peak oxygen consumption (VO2)]. We measured the transmitral E and A flow velocities, E/A ratio, and E deceleration time (DT) and tissue Doppler E' velocity. We also indexed the E' to the DT, as additional measure of impaired relaxation (E'(DT)), and calculated the diastolic functional reserve index (DFRI), as the product of E' at rest and change in E' with exercise.Results E' velocity, at rest and peak exercise, as well as the DFRI positively correlated with peak VO2, whereas DT, E'(DT), and E/E' with exercise inversely correlated with peak VO2. Of note, the E'(DT) at rest also significantly predicted E' velocity at peak exercise (R = +0.81, P < 0.001). 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.