Quality of life questionnaire predicts poor exercise capacity only in HFpEF and not in HFrEF

Abstract

BackgroundThe Minnesota Living with Heart Failure Questionnaire (MLHFQ) is the most widely used measure of quality of life (QoL) in HF patients. This prospective study aimed to assess the relationship between QoL and exercise capacity in HF patients.MethodsThe study subjects were 118 consecutive patients with chronic HF (62 ± 10 years, 57 females, in NYHA I-III). Patients answered a MLHFQ questionnaire in the same day of complete clinical, biochemical and echocardiographic assessment. They also underwent a 5 min walk test (6-MWT), in the same day, which grouped them into; Group I: ≤ 300 m and Group II: >300 m. In addition, left ventricular (LV) ejection fraction (EF), divided them into: Group A, with preserved EF (HFpEF) and Group B with reduced EF (HFrEF).ResultsThe mean MLHFQ total scale score was 48 (±17). The total scale, and the physical and emotional functional MLHFQ scores did not differ between HFpEF and HFpEF. Group I patients were older (p = 0.003), had higher NYHA functional class (p = 0.002), faster baseline heart rate (p = 0.006), higher prevalence of smoking (p = 0.015), higher global, physical and emotional MLHFQ scores (p < 0.001, for all), larger left atrial (LA) diameter (p = 0.001), shorter LV filling time (p = 0.027), higher E/e’ ratio (0.02), shorter isovolumic relaxation time (p = 0.028), lower septal a’ (p = 0.019) and s’ (p = 0.023), compared to Group II.Independent predictors of 6-MWT distance for the group as a whole were increased MLHFQ total score (p = 0.005), older age (p = 0.035), and diabetes (p = 0.045), in HFpEF were total MLHFQ (p = 0.007) and diabetes (p = 0.045) but in HFrEF were only LA enlargement (p = 0.005) and age (p = 0.013. A total MLHFQ score of 48.5 had a sensitivity of 67% and specificity of 63% (AUC on ROC analysis of 72%) for limited exercise performance in HF patients.ConclusionsQuality of life, assessment by MLHFQ, is the best correlate of exercise capacity measured by 6-MWT, particularly in HFpEF patients. Despite worse ejection fraction in HFrEF, signs of raised LA pressure independently determine exercise capacity in these patients.Electronic supplementary materialThe online version of this article (10.1186/s12872-017-0705-0) contains supplementary material, which is available to authorized users.

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

“…Chronotropic incompetence is present in 33–77% of HFpEF patients, 188 , 189 and defined as the failure to reach 70–80% 188–190 of the predicted maximal heart rate. Reduced heart rate recovery after exercise has prognostic value 191–193 . Reduced exercise capacity can be defined as a peak workload ≤75% of the value predicted for age.…”

“…Reduced heart rate recovery after exercise has prognostic value. [191][192][193] Reduced exercise capacity can be defined as a peak workload ≤75% of the value predicted for age. In elderly patients with suspected HFpEF a 6-minute walk test (6MWT)…”

Predictors of pre-rehabilitation exercise capacity in elderly European cardiac patients – The EU-CaRE study

“…(30) Previous studies assessing the associations between CVRF and comorbidities with peak VO2 were performed in much smaller populations and, possibly as a consequence, only found some of these factors to be significant. (31,32) Reference ranges…”

Relationships between exercise capacity and anxiety, depression, and cognition in patients with heart failure

“…3,10 Despite the positive effects of exercise training on outcomes, only about 30% of the HF patients adhere to their exercise recommendations. 11 Several factors are related to the exercise capacity of HF patients, 12,13 including symptoms of anxiety, depression, and cognitive impairment 12,[14][15][16][17][18] ; however, their roles remain unclear, and the study results are inconsistent. With regard to anxiety, some studies have found that a higher anxiety level is associated with a lower exercise capacity in HF patients, 17 but other studies have not confirmed this.…”