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Mitral systolic velocity at peak exercise predicts impaired exercise capacity in patients with heart failure with preserved ejection fraction
Author(s) -
Masada Kenji,
Hidaka Takayuki,
Harada Yu,
Kinoshita Mirai,
Itakura Kiho,
Higashi Akifumi,
Utsunomiya Hiroto,
Kihara Yasuki
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13440
Subject(s) - ejection fraction , cardiology , heart failure , medicine , stroke volume , confidence interval , vo2 max , area under the curve , cardiac output , heart rate , hemodynamics , blood pressure
Background Nearly half of patients with heart failure have normal left ventricular ejection fraction ( LVEF ), but their prognosis is no better than those with reduced LVEF . Although peak oxygen consumption ( VO 2 ) is an independent predictor of mortality in heart failure, it is unclear how cardiac function during exercise contributes to peak VO 2 . Therefore, we explored the useful parameters measured by exercise stress echocardiography to predict peak VO 2 in patients with heart failure with preserved LVEF ( HF p EF ). Methods and Results We assessed 80 patients being investigated for effort intolerance or dyspnea and finally analyzed 50 patients who satisfied the HF p EF criteria. Mean peak VO 2 was 16.4±2.8 mL/kg/min. Twenty‐three patients (46.0%) achieved a peak VO 2 <16.0 mL/kg/min (Weber class C or D). There was a significant relationship between mitral systolic velocity (S′) and cardiac output ( CO ) at rest ( R =.55, P <.0001) and peak exercise ( R =.64, P <.0001). The absolute increase in S′ from rest to peak exercise also correlated with the absolute increase in CO ( R =.32, P =.02). Multivariate logistic regression analysis showed that S′ at peak exercise independently predicted peak VO 2 . Receiver‐operator characteristic curve analysis identified that an S′ at peak exercise of ≤8.13 cm/s predicted a peak VO 2 <16.0 mL/kg/min (sensitivity 95.7%, specificity 44.4%, area under curve 0.70, 95% confidence interval 0.55‐0.84, P =.004). Conclusions Mitral systolic velocity at peak exercise accurately reflects peak VO 2 and may facilitate stratification of risk in patients with HF p EF .