Left atrial volume as an independent predictor of exercise capacity in patients with isolated diastolic dysfunction presented with exertional dyspnea

Abstract

BackgroundLeft atrial volume (LAV) and exercise capacity are important prognostic determinants of cardiovascular risk. Exercise intolerance and increased LAV are expected in patients with diastolic dysfunction. While dyspnea is the symptom reported by the patient and considered subjective, exercise capacity obtained by exercise testing provides an objective measure of cardiovascular fitness. The objective of this study is to determine the relationship between LAV index and exercise capacity in patients with isolated diastolic dysfunction who presented with exertional dyspnea.MethodsWe studied consecutive patients with dyspnea who underwent treadmill exercise testing and transthoracic echocardiography on the same day. LAV was assessed using the biplane area-length method. Symptom-limited exercise testing was performed immediately after echocardiography. Patients with coronary artery disease, valvular or congenital heart disease, left ventricular systolic dysfunction, pulmonary hypertension or positive exercise test were excluded.ResultsThe study consisted of 111 patients (58.1 ± 9.2 years of age, 54.1% male, 64% hypertension, 57.7% dyslipidemia and 20.7% diabetes). The exercise duration and capacity were 6.8 ± 2.1 minutes and 7.7 ± 1.9 METs, respectively. Left ventricular ejection fraction and LAV index was 71.0 ± 5.8% and 31.4 ± 10.5 ml/m2, respectively. In multivariate analysis, age [odds ratios (OR) 0.94; 95% confidence interval (CI) 0.89-0.99], body mass index (OR 0.82, 95% CI 0.72-0.93), and LAV index (OR 0.92, 95% CI 0.87-0.97) were associated with good exercise capacity.ConclusionIn patients with isolated diastolic dysfunction and exertional dyspnea, an increased LAV index, a marker of chronic diastolic dysfunction, is associated with poor exercise capacity.

Global longitudinal strain, ejection fraction, effort tolerance and normal echocardiography measurements in healthy Indians

“…Maximal exercise capacity was defined by the achieved metabolic equivalents (METs). Mets equal 3.5 mL of oxygen uptake per kilogram of body weight per minute and are estimated from exercise time as METs = 1.1 + (0.016 × exercise time in seconds) 7 . Patients with good exercise capacity were defined as those who achieved ≥7 METs.…”

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

“…The left atrial volume indexed by body surface (ILAV) in patients with HFPEF seems to be an important variable and is currently being increasingly valued, since in many studies it has proven to be an independent predictor of exercise capacity 28 . The present results show significant differences between the population samples of HFPEF and healthy individuals.…”

Association among Dyspnea and the Degrees of Diastolic Dysfunction at Echocardiography

“…Além disso, o tamanho do AE não se associou positivamente com a presença de dispneia nos participantes com DDVE. Segundo Ratanasit et al, 20 que utilizou teste de esforço para avaliação da dispneia, a dilatação atrial (43 ± 6,1) é capaz de predizer menor tolerância ao exercício. 20 Contudo, a presente investigação da dispneia se deu apenas com critérios clínicos (mMRC) e não foi encontrada diferença significativa entre as dimensões do AE dos grupos caso e controle.…”