Cardiopulmonary Exercise Testing Variables Reflect the Degree of Diastolic Dysfunction in Patients With Heart Failure-Normal Ejection Fraction
Cardiopulmonary Exercise Testing Variables Reflect the Degree of Diastolic Dysfunction in Patients With Heart Failure-Normal Ejection Fraction
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DOI：
10.1097/hcr.0b013e3181d0c1ad
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发表时间：
2010-05-01
影响因子：
3.8
通讯作者：
Arena, Ross
中科院分区：
文献类型：
--
作者：
Guazzi, Marco;Myers, Jonathan;Arena, Ross
目的：先前的研究报告了在收缩性心力衰竭(HF)队列中，组织多普勒超声心动图(TDI)获得的变量与心肺运动试验(CPX)之间的关系。方法：应用TDI和CPX对32例心衰患者进行超声心动图检查，测定二尖瓣早期血流速度(E)与二尖瓣环血流速度(E‘)的比值，(2)射血分数，(3)左心室重量(LV)，(4)左心室收缩末期容量(4)，(5)最大摄氧量(V)，(2)呼吸效率，(4)左心室收缩末期容量。(7)静息和高峰运动时呼气末二氧化碳分压(PETCO2)；(8)1分钟心率恢复(HRR1)。结果：Pearson相关分析显示E/E‘与最大摄氧量(r=-0.55，P=.001)、呼吸机效率斜率(r=0.60，P<)显著相关；.001)，静息PETCO2(r=-0.39，P=0.03)，PETCO2峰值(r=-0.50，P=0.004)，HRR1(r=-0.63，P<0.01)。左心室重量和左心室收缩末期容量与任何CPX变量均无相关性。射血分数与心率变异性相关(r=-0.55，P=.001)。HRR1阈值小于16和/或每分钟搏动16次或更多(较高值为阳性)可有效地识别E/E‘和GT；10(阳性似然比：13：2)。讨论：E/E’可准确反映左心室充盈压力，从而洞察舒张期功能。目前的研究结果表明，CPX可以深入了解HF-NEF患者的心功能障碍，因此，最终可能被证明是一种有价值的和被接受的临床评估。
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 ((V) over dotO(2)), (6) ventilatory efficiency, (7) the partial pressure of end-tidal carbon dioxide (PETCO2) 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 < .001), resting PETCO2 (r = -0.39, P = .03), peak PETCO2 (r = -0.50, P = .004), and HRR1 (r = -0.63, P < .001). Left ventricular mass and left ventricular end systolic volume were not correlated with any CPX variable. Ejection fraction was correlated with HRR1 (r = -0.55, P = .001). An HRR1 threshold of less than 16 and/or 16 or more beats per minute (higher value positive) effectively identified subjects with an E/E' > 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.