Resting echocardiographic assessments of left atrial function and filling pressure interest in the understanding of exercise capacity in patients with chronic congestive heart failure.
OBJECTIVE
Doppler echocardiography is well recognized as the primary noninvasive imaging technique to assess global and regional cardiac function. Cardiopulmonary exercise testing has become a powerful tool to predict outcome in chronic heart failure (CHF). We looked for cardiac determinants, using resting echocardiographic parameters, of exercise tolerance in patients with CHF.


METHODS
Transthoracic echocardiography and standardized cardiopulmonary exercise testing were performed in 75 patients (59 +/- 11 years) with CHF, New York Heart Association functional class II to III. Systolic and diastolic function, filling pressures, and left ventricular, right ventricular, and left atrial (LA) regional function were assessed using Doppler tissue velocities and strain values.


RESULTS
Maximal workload (86 +/- 41 W) and peak oxygen (14.6 +/- 3.1 mL/min/kg) correlated with left ventricular filling pressure estimates (E/Ea and E/Vp) but also with end-diastolic pulsed Doppler tissue velocity at the mitral annulus (Aa), LA volume, and regional LA function assessed by strain analysis. In multivariate analysis, maximum workload and peak oxygen were shown to correlate with right ventricular peak strain, although Aa and E/Ea were the best predictors of exercise capacity.


CONCLUSIONS
Capacity to exercise in patients with CHF is understandable by resting echocardiography. Filling pressures, and LA and right ventricular functions, are its cardiac best determinants. Adding Aa peak velocity in resting echocardiographic evaluation of patients with CHF is found useful.
Donal
Erwan
E
Department of Cardiology, University Hospital Rennes, Rennes, France. erwan.donal@chu-rennes.fr
Raud-Raynier
Pascale
P
De Place
Christian
C
Gervais
Renaud
R
Rosier
Arnaud
A
Roulaud
Manuel
M
Ingels
Anne
A
Carre
François
F
Daubert
Jean-Claude
JC
Denjean
André
A
D016279:Atrial Function, Left; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011379:Prognosis; D011446:Prospective Studies; D012146:Rest; D013599:Systole; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging