title: Relation of ventricular-vascular coupling to exercise capacity in ischemic cardiomyopathy: a cardiac multi-modality imaging study.
abstract: The purpose of this study was to examine the relationship between noninvasive measurements of ventricular-vascular coupling (VVC) with exercise tolerance, and compared the value of VVC versus other traditional determinants of exercise capacity in this population. 43 patients with ischemic CMP (age 59 +/- 9 years, mean EF 24 +/- 8%) underwent cardiopulmonary exercise testing, echocardiography and cardiac magnetic resonance (CMR). VVC was defined non-invasively by the ratio of ventricular systolic elastance (Ees) to the arterial elastance (Ea), where Ees = end-systolic pressure/end-systolic volume index and Ea = end-systolic pressure/stroke volume index. VVC significantly correlated with baseline heart rate (HR), peak exercise systolic blood pressure, maximum oxygen consumption (MVO(2)) and peak O(2) pulse (MVO(2)/HR). A higher VVC was associated with higher LVEF and RVEF but showed inverse relation to mitral E wave velocity. Univariate predictors of MVO(2) are baseline HR, chronotropic reserve, VVC and aortic distensibility; whilst mitral E wave velocity, LVEF, VVC, Ees significantly correlated with peak O(2) pulse. By stepwise multivariate analysis, VVC remained the only independent predictor of peak O(2) pulse. Ventricular-vascular coupling at rest may be a clinically important parameter in predicting exercise capacity in patients with advanced heart failure, and may become an additional target for therapeutic interventions.
authors.affiliation: Department of Cardiovascular Medicine/F15, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA, rwongcc@gmail.com.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Wong
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Dumont
authors.forename: Bethany A
authors.initials: BA
authors.lastname: Austin
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Kwon
authors.forename: Scott D
authors.initials: SD
authors.lastname: Flamm
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.forename: Milind Y
authors.initials: MY
authors.lastname: Desai
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000503:physiopathology*; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D004548:Elasticity; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D006339:Heart Rate; D016027:Heart Transplantation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D015588:Observer Variation; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013318:Stroke Volume; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D017725:Ventricular Pressure