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Relationship of Doppler-Echocardiographic left ventricular diastolic function to exercise performance in systolic heart failure: the HF-ACTION study.
Am Heart J. 2009 Oct; 158(4 Suppl):S45-52.AH

Abstract

INTRODUCTION

Patients with systolic heart failure often have concomitant left ventricular (LV) diastolic dysfunction. Although in animal models diastolic dysfunction is associated with worsening exercise capacity and prognosis, information regarding these relationships in patients with established systolic heart failure (HF) is sparse.

METHODS

HF-ACTION was a large, multicenter National Institutes of Health-funded trial of exercise training in systolic HF (LV ejection fraction [LVEF] < or = 35%) and included detailed Doppler-echocardiographic (echo) and cardiopulmonary exercise testing at baseline. We tested the hypothesis that echo measures of LV diastolic function predict key cardiopulmonary exercise outcomes, including aerobic exercise capacity (peak exercise oxygen consumption, VO(2)), distance in the 6-minute walk test (6MWD), and ventilatory efficiency (VE/VCO(2) slope) in patients with systolic HF.

RESULTS

Overall, 2,331 patients (28% women, median age 59 years, median LVEF 25%) were enrolled. There were significant bivariate correlations between echo diastolic function variables and peak VO(2) (inverse) and VE/VCO(2) slope (direct) that were strongest for ratio of early diastolic peak transmitral (MV) to myocardial tissue velocity (E/E'), peak MV early-to-late diastolic velocity ratio (E/A), and left atrial dimension (range of absolute r = 0.16-0.28). Both MV E/A and E/E' were more strongly related to all 3 exercise variables than was LVEF. The relationships of E/A and E/E' with 6MWD were weaker than with peak VO(2) or VE/VCO(2) slope. A multivariable model with peak VO(2) as the dependent variable, which included MV E/A and 9 demographic predictors including age, sex, race, body mass index, and New York Heart Association class, explained 40% of the variation in peak VO(2), with MV E/A explaining 6% of the variation. Including LVEF in the model explained less than an additional 1% of the variance in peak VO(2). In a multivariable model for VE/VCO(2) slope, MV E/A was the strongest independent echo predictor, explaining 10% of the variance. The relationship of LV diastolic function variables with 6MWD was weaker than with peak VO(2) or VE/VCO(2) slope.

CONCLUSION

In patients with systolic HF, LV early diastolic function is a modest independent predictor of aerobic exercise capacity and appears to be a better predictor than LVEF.

Authors+Show Affiliations

St. John Hospital and Medical Center, Detroit, MI; Hackensack University Medical Center, Hackensack, NJ 07601, USA. JGardin@humed.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

19782788

Citation

Gardin, Julius M., et al. "Relationship of Doppler-Echocardiographic Left Ventricular Diastolic Function to Exercise Performance in Systolic Heart Failure: the HF-ACTION Study." American Heart Journal, vol. 158, no. 4 Suppl, 2009, pp. S45-52.
Gardin JM, Leifer ES, Fleg JL, et al. Relationship of Doppler-Echocardiographic left ventricular diastolic function to exercise performance in systolic heart failure: the HF-ACTION study. Am Heart J. 2009;158(4 Suppl):S45-52.
Gardin, J. M., Leifer, E. S., Fleg, J. L., Whellan, D., Kokkinos, P., Leblanc, M. H., Wolfel, E., & Kitzman, D. W. (2009). Relationship of Doppler-Echocardiographic left ventricular diastolic function to exercise performance in systolic heart failure: the HF-ACTION study. American Heart Journal, 158(4 Suppl), S45-52. https://doi.org/10.1016/j.ahj.2009.07.015
Gardin JM, et al. Relationship of Doppler-Echocardiographic Left Ventricular Diastolic Function to Exercise Performance in Systolic Heart Failure: the HF-ACTION Study. Am Heart J. 2009;158(4 Suppl):S45-52. PubMed PMID: 19782788.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship of Doppler-Echocardiographic left ventricular diastolic function to exercise performance in systolic heart failure: the HF-ACTION study. AU - Gardin,Julius M, AU - Leifer,Eric S, AU - Fleg,Jerome L, AU - Whellan,David, AU - Kokkinos,Peter, AU - Leblanc,Marie-Helene, AU - Wolfel,Eugene, AU - Kitzman,Dalane W, AU - ,, PY - 2009/9/29/entrez PY - 2009/10/15/pubmed PY - 2009/10/30/medline SP - S45 EP - 52 JF - American heart journal JO - Am. Heart J. VL - 158 IS - 4 Suppl N2 - INTRODUCTION: Patients with systolic heart failure often have concomitant left ventricular (LV) diastolic dysfunction. Although in animal models diastolic dysfunction is associated with worsening exercise capacity and prognosis, information regarding these relationships in patients with established systolic heart failure (HF) is sparse. METHODS: HF-ACTION was a large, multicenter National Institutes of Health-funded trial of exercise training in systolic HF (LV ejection fraction [LVEF] < or = 35%) and included detailed Doppler-echocardiographic (echo) and cardiopulmonary exercise testing at baseline. We tested the hypothesis that echo measures of LV diastolic function predict key cardiopulmonary exercise outcomes, including aerobic exercise capacity (peak exercise oxygen consumption, VO(2)), distance in the 6-minute walk test (6MWD), and ventilatory efficiency (VE/VCO(2) slope) in patients with systolic HF. RESULTS: Overall, 2,331 patients (28% women, median age 59 years, median LVEF 25%) were enrolled. There were significant bivariate correlations between echo diastolic function variables and peak VO(2) (inverse) and VE/VCO(2) slope (direct) that were strongest for ratio of early diastolic peak transmitral (MV) to myocardial tissue velocity (E/E'), peak MV early-to-late diastolic velocity ratio (E/A), and left atrial dimension (range of absolute r = 0.16-0.28). Both MV E/A and E/E' were more strongly related to all 3 exercise variables than was LVEF. The relationships of E/A and E/E' with 6MWD were weaker than with peak VO(2) or VE/VCO(2) slope. A multivariable model with peak VO(2) as the dependent variable, which included MV E/A and 9 demographic predictors including age, sex, race, body mass index, and New York Heart Association class, explained 40% of the variation in peak VO(2), with MV E/A explaining 6% of the variation. Including LVEF in the model explained less than an additional 1% of the variance in peak VO(2). In a multivariable model for VE/VCO(2) slope, MV E/A was the strongest independent echo predictor, explaining 10% of the variance. The relationship of LV diastolic function variables with 6MWD was weaker than with peak VO(2) or VE/VCO(2) slope. CONCLUSION: In patients with systolic HF, LV early diastolic function is a modest independent predictor of aerobic exercise capacity and appears to be a better predictor than LVEF. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/19782788/Relationship_of_Doppler_Echocardiographic_left_ventricular_diastolic_function_to_exercise_performance_in_systolic_heart_failure:_the_HF_ACTION_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(09)00556-0 DB - PRIME DP - Unbound Medicine ER -