Impaired myocardial relaxation with exercise determines peak aerobic exercise capacity in heart failure with preserved ejection fraction

Abstract

BackgroundHeart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by impaired exercise capacity due to shortness of breath and/or fatigue. Assessment of diastolic dysfunction at rest and with exercise may provide insight into the pathophysiology of exercise intolerance in HFpEF.AimsTo measure echocardio‐Doppler‐derived parameters of diastolic function as they relate to various indices of aerobic exercise capacity in HFpEF.MethodsWe selected 16 subjects with clinically stable HFpEF, no evidence of volume overload, but impaired functional capacity by cardiopulmonary exercise testing [peak oxygen consumption (VO2)]. We measured the transmitral E and A flow velocities, E/A ratio, and E deceleration time (DT) and tissue Doppler E′ velocity. We also indexed the E′ to the DT, as additional measure of impaired relaxation (E′DT), and calculated the diastolic functional reserve index (DFRI), as the product of E′ at rest and change in E′ with exercise.ResultsE′ velocity, at rest and peak exercise, as well as the DFRI positively correlated with peak VO2, whereas DT, E′DT, and E/E′ with exercise inversely correlated with peak VO2. Of note, the E′DT at rest also significantly predicted E′ velocity at peak exercise (R = +0.81, P < 0.001). Exercise E′ was the only independent predictor of peak VO2 at multivariable analysis (R = +0.67, P = 0.005).ConclusionsThe E′ velocity at peak exercise is a strong and independent predictor of aerobic exercise capacity as measured by peak VO2 in patients with HFpEF, providing the link between abnormal myocardial relaxation with exercise and impaired aerobic exercise capacity in HFpEF.

IL-1 Blockade in Patients With Heart Failure With Preserved Ejection Fraction

“…Assessment of left ventricular ejection fraction and E/e’ at rest offer a limited assessment of the cardiac function in patients with HFpEF, and assessment with exercise is preferred. 40 However, obtaining images of sufficient quality in obese patients at peak exercise is challenging, and data in this study were available only in 60% of patients at peak exercise, thus further limiting the power of the assessment.…”

The effects of canagliflozin compared to sitagliptin on cardiorespiratory fitness in type 2 diabetes mellitus and heart failure with reduced ejection fraction: The CANA‐HF study

“…We measured LV end‐diastolic and LV end‐systolic volumes, LVEF, and early transmitral velocity (E) on pulsed‐wave Doppler spectra and early mitral annular velocities by tissue Doppler averaged between the lateral and septal (E′) annulus; these measures were used to calculate the E/E′ ratio. We also measured deceleration time (DT) and calculated the E′ velocity indexed by DT (E′ DT ) 16 …”

Preserved cardiac function by vinculin enhances glucose oxidation and extends health- and life-span

“…The resulting cardiac-specific over-expression of VincHE hearts resulted in higher basal wall shortening velocities, increased velocity under viscous load, and a less severe load dependent decline in fractional shortening, i.e., the ratio of tube diameter change to its diastolic diameter. 9 While evidence supports a link between cardiovascular function and aerobic exercise capacity 21 as well as its age-associated decline, 22-24 it is not clear to what extent and how systemic changes result from cardiac-specific sarcomere changes. Thus, we assessed the fitness of VincHE flies as a function of age using the rapid iterative negative geotaxis (RING) assay, which assesses the natural climbing response in flies.…”