Ergospirometry and Echocardiography in Early Stage of Heart Failure with Preserved Ejection Fraction and in Healthy Individuals

Abstract

BackgroundHeart failure with preserved ejection fraction is a syndrome characterized by changes in diastolic function; it is more prevalent among the elderly, women, and individuals with systemic hypertension (SH) and diabetes mellitus. However, in its early stages, there are no signs of congestion and it is identified in tests by adverse remodeling, decreased exercise capacity and diastolic dysfunction.ObjectiveTo compare doppler, echocardiographic (Echo), and cardiopulmonary exercise test (CPET) variables - ergospirometry variables - between two population samples: one of individuals in the early stage of this syndrome, and the other of healthy individuals.MethodsTwenty eight outpatients diagnosed with heart failure according to Framingham’s criteria, ejection fraction > 50% and diastolic dysfunction according to the european society of cardiology (ESC), and 24 healthy individuals underwent Echo and CPET.ResultsThe group of patients showed indexed atrial volume and left ventricular mass as well as E/E’ and ILAV/A´ ratios significantly higher, in addition to a significant reduction in peak oxygen consumption and increased VE/VCO2 slope, even having similar left ventricular sizes in comparison to those of the sample of healthy individuals.ConclusionThere are significant differences between the structural and functional variables analyzed by Echo and CPET when comparing two population samples: one of patients in the early stage of heart failure with ejection fraction greater than or equal to 50% and another of healthy individuals.

The interplay between metabolic alterations, diastolic strain rate and exercise capacity in mild heart failure with preserved ejection fraction: a cardiovascular magnetic resonance study

“…All HFpEF patients had (1) signs or symptoms of HF, (2) normal LVEF and LV cavity size, (3) evidence of mild diastolic dysfunction on Doppler echocardiography, and, additionally (4), objective evidence of cardiac cause of exercise limitation on CPET. We decided to use the latter as an additional inclusion criterion, as this provided evidence of a cardiac cause of exercise intolerance in our mild HFpEF population, rather than being attributed to physical deconditioning, commonly seen in healthy elderly [16, 25, 26], and the predicted values are entirely consistent with a meta-analysis of studies from which reference values were developed [27].…”

Efeito de diferentes modalidades de treinamento físico no consumo de oxigênio de pico em pacientes pós-infarto agudo do miocárdio: uma revisão sistemática e metanálise

“… 44 , 45 Cardiac function also exhibits improved performance after an intervention with aerobic exercise, with increased diastolic filling and a concomitant combination of increased preload and optimized myocardium relaxation. 46 The improved cardiac function will provoke important benefits for reduction of diastole duration and more efficient diastolic filling. 46 …”

“… 46 The improved cardiac function will provoke important benefits for reduction of diastole duration and more efficient diastolic filling. 46 …”

“…Além disso, o exercício aeróbico de modo geral aumenta a diferença arteriovenosa de oxigênio, a qual está diretamente relacionada ao aumento no VO2pico, por meio de uma maior oferta de oxigênio periférico, em função da produção de catecolaminas e maior biodisponibilidade de óxido nítrico 44 , 45 . A função cardíaca também apresenta maior desempenho após uma intervenção com exercício aeróbico, quando ocorre um aumento no enchimento diastólico, com uma concomitante combinação de pré-carga aumentada e relaxamento do miocárdio otimizado 46 . A melhora na função cardíaca promoverá importantes benefícios para a redução no tempo de diástole e maior eficiência no enchimento diastólico 46 .…”

Caminhada de Longa Duração pode Alterar Biomarcadores Cardíacos e Variáveis Ecocardiográficas Relacionadas à Função Diastólica?

“…4 Among the markers of altered cardiac function, we can highlight some echocardiographic variables, such as early (E) and late transmitral diastolic velocities (A), as well as the E / A ratio, as well as early diastolic velocity by tissue-Doppler (E'), all of which can be used to analyze diastolic dysfunction. 6 The available scientific evidence on the effects of longdistance walking on cardiac biomarkers and diastolic function shows divergent results regarding cardiovascular risk for this type of modality. In this issue of the journal, Euzébio et al 7 explore this topic in long-distance walking participants (mean age 46 ± 10.5).…”