Echocardiography with Tissue Doppler Imaging and cardiopulmonary exercise testing in patients with heart failure: A correlative and prognostic analysis

Guazzi, Marco; Myers, Jonathan; Peberdy, Mary Ann; Bensimhon, Daniel; Chase, Paul; Pinkstaff, Sherry; Arena, Ross

doi:10.1016/j.ijcard.2009.03.053

Cited by 19 publications

(17 citation statements)

References 36 publications

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“…Increased E/E' or increased systolic pulmonary artery pressure with higher RDW might be another explanation why CHF patients with higher RDW have exercise intolerance and ventilatory inefficiency. Our findings are consistent with previous studies that report LV diastolic dysfunction as being more likely to present a poorer CPET response (higher VE/VCO 2 slope, lower peak VO 2 ) 19,30. Interestingly, in the present study, both peak VO 2 and VE/VCO 2 slope were significantly correlated with E/E' and LVEF, but only E/E' remained as an independent predictor for peak VO 2 and VE/VCO 2 slope.…”

Section: Discussionsupporting

confidence: 93%

Red Cell Distribution Width as an Independent Predictor of Exercise Intolerance and Ventilatory Inefficiency in Patients with Chronic Heart Failure

Hong

Youn

et al. 2014

Yonsei Med J

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PurposePeak oxygen uptake (peak VO2) and ventilatory inefficiency (VE/VCO2 slope) have proven to be strong prognostic markers in patients with chronic heart failure (CHF). Recently increased red cell distribution width (RDW) has emerged as an additional predictor of poor outcome in CHF. We sought to evaluate the relationship between RDW and cardiopulmonary exercise test (CPET) parameters in CHF patients and healthy controls.Materials and Methods85 ambulatory CHF patients (68 men, 54±10 years) and 107 healthy controls, who underwent a symptom-limited CPET on a treadmill according to the modified Bruce ramp protocol, were enrolled. CHF patients and healthy controls were divided into RDW tertile groups and laboratory, echocardiographic, and CPET results were analyzed.ResultsFor patients with CHF, compared with patients in the lowest RDW tertile, those in the highest tertile had lower peak VO2 (22 mL/kg/min vs. 28 mL/kg/min, p<0.001) and higher VE/VCO2 slope (31 vs. 25, p=0.004). Multivariate regression analysis revealed RDW to be an independent predictor for peak VO2 (β=-0.247, p=0.035) and VE/VCO2 slope (β=0.366, p=0.004). The optimal cutoff value of RDW for predicting peak VO2 ≤20 mL/kg/min and VE/VCO2 slope ≥34 was 13.6% (sensitivity 53%, specificity 89%) and 13.4% (sensitivity 75%, specificity 82%), respectively. In contrast, for healthy controls, RDW was not related to both peak VO2 and VE/VCO2 slope.ConclusionHigher RDW is independently related to peak VO2 and VE/VCO2 slope only in patients with CHF. RDW assessment, an inexpensive and simple method, might help predict functional capacity and ventilatory efficiency in these patients.

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Section: Discussionsupporting

confidence: 93%

Red Cell Distribution Width as an Independent Predictor of Exercise Intolerance and Ventilatory Inefficiency in Patients with Chronic Heart Failure

Hong

Youn

et al. 2014

Yonsei Med J

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“…We retrospectively assessed the usefulness of combining information from standard echocardiography and the cardiopulmonary exercise test in ambulatory elderly patients with systolic heart failure who were clinically stable, had mild to moderate symptoms and were well treated with neurohormonal antagonists and electrical therapies; they represent the majority of patients in this age group. 19,20 Indeed, relevant prognostic information was derived from both tests, similar to what was recently observed in a population 15 years younger by Guazzi et al 15 …”

Section: Discussionsupporting

confidence: 72%

“…Conversely, NYHA class was correlated to VEVCO 2 slope and peak RQ, indexes of the ventilatory effort; moreover, diastolic function progressively worsened across the four ventilatory classes (VC) suggested by Arena et al 19 (Figure 1). 15 ). Therefore, survival curves and receiver operating characteristic (ROC) curves were built taking into account these variables.…”

Section: Results Populationmentioning

confidence: 99%

“…[12][13][14] Even less information is available on the correlation between stress test results and indexes of systolic and diastolic function, and on the prognostic significance of their association in elderly patients. 15 Thus, we analyzed the prevalence and mutual relationship of echocardiographic markers of unfavorable prognosis, such as mitral regurgitation and diastolic dysfunction, with exercise test characteristics in a population of aged heart failure patients.…”

Section: Introductionmentioning

confidence: 99%

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Diastolic dysfunction and abnormal exercise ventilation predict adverse outcome in elderly patients with chronic systolic heart failure

Malfatto

Branzi

Giglio

et al. 2011

Eur J Prev Cardiolog

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“…Impaired peak VO 2 has been associated with increased mortality risk [20] and decreased quality of life in heart failure patients. As measured by traditional indices such as ejection fraction, systolic function appears largely normal under resting baseline conditions in HFpEF.…”

Section: Introductionmentioning

confidence: 99%

Exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis

Chan¹,

Giallauria

Vigorito

et al. 2016

Monaldi Arch Chest Dis

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Exercise training induces physical adaptations for heart failure patients with systolic dysfunction but less is known about those patients with preserved ejection fraction. This study's aims were to establish if exercise training produces changes in peak VO 2 and related measures, quality of life, general health and diastolic function in heart failure patients with preserved ejection fraction (HFpEF).We conducted a MEDLINE search (1985( to September 1, 2015, for exercise based rehabilitation trials in heart failure, using search terms 'exercise training, heart failure with preserved ejection fraction, heart failure with normal ejection fraction, peak VO 2 and diastolic heart dysfunction'. Eight intervention studies were included providing a total of 174 exercising subjects and 143 control subjects, a total of 317 participants.Peak VO 2 increased by a mean difference (MD) 2.08 mL kg -1 min -1 (95% C.I. 1.51 to 2.65, p<0.00001) in exercise training versus sedentary control, equating to a 17% improvement from baseline. V E /VCO 2 slope was not different between groups, MD -3.10 mL kg -1 min -1 (95% C.I. -7.47 to 1.27, p=0.16); maximum heart rate was significantly increased in exercise groups, MD 3.46 bpm (95% C.I. 2.41 to 4.51, p<0.00001); 6 Minute Walk Distance (6MWT) MD 32.1m (95% C.I. 17.2 to 47.1, p<0.0001); diastolic function; the ratio of early to late filling (E/A ratio) was improved after exercise training MD 0.07 (95% C.I. 0.02 to 0.12, p=0.006); as was filling pressure E/E' ratio MD -2.38 (95% C.I. -3.47 to -1.28, p<0.0001); Deceleration time (D T ) MD -13.2 msec (95% C.I. -19.8 to -6.5, p=0.0001); Minnesota Living with Heart Failure Questionnaire (MLHFQ) MD -6.77 (95% C.I. -9.70 to -3.84, p<0.00001); Short Form-36 Health Survey MD 11.38 (95% C.I. 5.28 to 17.48, p=0.0003). In 3222 patient-hours of training, not a single death was directly attributable to exercise.Exercise training appears to effect several health-related improvements in people with heart failure and preserved ejection fraction.

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Echocardiography with Tissue Doppler Imaging and cardiopulmonary exercise testing in patients with heart failure: A correlative and prognostic analysis

Cited by 19 publications

References 36 publications

Red Cell Distribution Width as an Independent Predictor of Exercise Intolerance and Ventilatory Inefficiency in Patients with Chronic Heart Failure

Red Cell Distribution Width as an Independent Predictor of Exercise Intolerance and Ventilatory Inefficiency in Patients with Chronic Heart Failure

Diastolic dysfunction and abnormal exercise ventilation predict adverse outcome in elderly patients with chronic systolic heart failure

Exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis

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