| 1. |
- Batalli, A., et al.
(författare)
-
Different predictors of exercise capacity in HFpEF compared to HFrEF
- 2017
-
Ingår i: European Journal of Heart Failure. - : European Society of Cardiology. - 1388-9842 .- 1879-0844. ; 19:1, s. 314-314
-
Tidskriftsartikel (refereegranskat)abstract
- Background and Aim: Quality of life is as important as survival in heart failure (HF) patients. Controversies exist with regards to echocardiographic predictors of exercise capacity in HF, particularly in patients with preserved ejection fraction (HFpEF). The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional exercise capacity assessed by 6 min walk test (6-MWT) in patients with HFpEF.Methods: In 111 HF patients (mean age 63± 10 years, 47% female), an echo-Doppler study and a 6-MWT were performed in the same day. Patients were divided into two groups based on the 6-MWT distance (Group I: ≤ 300 m and Group II: >300 m).Results: Group I were older (p=0.008), had higher prevalence of diabetes (p=0.027), higher baseline heart rate (p=0.004), larger left atrium - LA (p=0.001), longer LV filling time - FT (p=0.019), shorter isovolumic relaxation time (p=0.037), shorter pulmonary acceleration time - PAAT (p=0.006), lower left atrial lateral wall myocardial velocity (a’) (p=0.018) and lower septal systolic myocardial velocity (s’) (p=0.023), compared with Group II. Patients with HF and reduced EF (HFrEF) had lower hemoglobin (p=0.007), higher baseline heart rate (p=0.005), higher NT-ProBNP (p=0.001), larger LA (p=0.004), lower septal s’, e’, a’ waves, and septal MAPSE, shorter PAAT (p < 0.001 for all), lower lateral MAPSE, higher E/A & E/e’, and shorter LVFT (p=0.001 for all), lower lateral e’ (p=0.009), s’ (p=0.006), RV e’ and LA emptying fraction (p=0.012 for both), compared with HFpEF patients. In multivariate analysis, only LA diameter [2.676 (1.242-5.766), p=0.012], and diabetes [0.274 (0.084 - 0.898), p=0.033] independently predicted poor 6-MWT performance in the group as a whole. In HFrEF, age [1.073 (1.012 - 1.137), p=0.018] and LA diameter [3.685 (1.348 - 10.071), p=0.011], but in HFpEF, lateral s’ [0.295 (0.099 - 0.882), p=0.029], and hemoglobin level [0.497 (0.248-0.998), p=0.049] independently predicted poor 6-MWT performance.Conclusion: In HF patients predictors of exercise capacity differ according to severity of overall LV systolic function, with left atrial enlargement in HFrEF and longitudinal systolic shortening in HFpEF as the the main predictors.
|
|
| 3. |
- Ibrahimi, P., et al.
(författare)
-
Enlarged left atrium and increased basal heart rate predict exercise capacity in heart failure patients
- 2017
-
Ingår i: European Journal of Heart Failure. - : European Society of Cardiology. - 1388-9842 .- 1879-0844. ; 19:S1, s. 582-583
-
Tidskriftsartikel (refereegranskat)abstract
- Background and aim: Heart failure (HF) is a major and growing health problem characterized by high mortality, frequent hospitalization, reduced quality of life and a complex therapeutic regimen. Six minute walking test (6-MWT) may serve as a reproducible test for assessing exercise capacity in HF patients and can be clinically predicted. The aim of this study was to assess clinical, biochemical and echocardiographical predictors of limited exercise capacity in HF patients.Methods: The study subjects were 135 consecutive clinically stable HF patients (64±11 years, 66 [47%] female, classified as NYHA I-III). Echocardiography, including tissue Doppler measurements, was performed in all patients. A six minute walk test (6-MWT) distance was performed in all patients, who were divided into two groups based on the 6-MWT distance (Group I: ≤ 300 m and Group II: >300 m).Results: Patients with limited exercise performance (≤ 300 m) were older (p<001), more frequent female (p=0.007) and diabetics (p=0.003), had lower level of hemoglobin (p=0.02), larger left atrium (LA, p=0.003), higher basal heart rate (p=0.009), higher E/e’ ratio (p=0.01) and lower septal systolic myocardial velocity (p=0.03) compared with good performance patients. Enlarged LA [2.856 (1.439-5.666), p=0.003], older age [1.110 (1.036-1.188), p=0.003], increased basal heart rate [1.055 (1.012-1.099), p=0.012] and the presence of diabetes [3.321 (1.022-10.796), p=0.046] independently predicted poor 6-MWT performance.Conclusions: In patients with HF, the limited exercise capacity assessed by 6-MWT, is related mostly to the enlarged left atrium as e reflection of longstanding increased left ventricular filling pressure, increased basal heart rate, in addition to the older age and the presence of diabetes. These findings highlights the need of the optimal medical treatment of HF patients towards the decreasing LV filling pressure and heart rate.
|
|
