title: The role of exercise echocardiography in the diagnostics of heart failure with normal left ventricular ejection fraction.
abstract: OBJECTIVE
  Few data are available on the exercise-induced abnormalities of myocardial function in patients with exertional dyspnoea and normal left ventricular ejection fraction (LV EF). The main aims of this study were to determine the prevalence of isolated exercise-induced heart failure with normal ejection fraction (HFNEF) and to assess whether disturbances in LV or right ventricular longitudinal systolic function are associated with the diagnosis of HFNEF.
  
  
  RESULTS
  Eighty-four patients with exertional dyspnoea and normal LV EF and 14 healthy controls underwent spirometry, NT-proBNP plasma analysis, and exercise echocardiography. Doppler LV inflow and tissue mitral and tricuspid annular velocities were analysed at rest and immediately after the termination of exercise. Of the 30 patients with the evidence of HFNEF, 6 (20%) patients had only isolated exercise-induced HFNEF. When compared with the remaining patients, those with HFNEF had a significantly lower resting and exercise peak mitral annular systolic velocity (Sa) and the mitral annular velocity during atrial contraction, lower exercise peak mitral annular velocity at early diastole, and lower exercise peak systolic velocity of tricuspid annular motion. The multivariate logistic regression analysis including both parameters standardly defining HFNEF and the new Doppler variables potentially associated with the diagnosis of HFNEF revealed that NT-proBNP, LV mass index, left atrial volume index, and Sa significantly and independently predict the diagnosis of HFNEF.
  
  
  CONCLUSIONS
  A significant proportion of patients require exercise to diagnose HFNEF. Sa appears to be a significant independent predictor of HFNEF, which may increase the diagnostic value of models utilizing the variables recommended by the European Society of Cardiology guidelines.
authors.affiliation: 1st Department of Internal Medicine/Cardioangiology , ICRC, St Anna Hospital, Masaryk University, Pekařská 53, 65691 Brno, Czech Republic. jaroslav.meluzin@fnusa.cz
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Meluzín
authors.forename: Jan
authors.initials: J
authors.lastname: Sitar
authors.forename: Jan
authors.initials: J
authors.lastname: Krístek
authors.forename: Robert
authors.initials: R
authors.lastname: Prosecky
authors.forename: Martin
authors.initials: M
authors.lastname: Pesl
authors.forename: Helena
authors.initials: H
authors.lastname: Podrouzková
authors.forename: Vladimír
authors.initials: V
authors.lastname: Soska
authors.forename: Roman
authors.initials: R
authors.lastname: Panovsky
authors.forename: Ladislav
authors.initials: L
authors.lastname: Dusek
mesh_terms: D000368:Aged; D019540:Area Under Curve; D004417:Dyspnea / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D015150:Echocardiography, Doppler / Q000295:instrumentation*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000295:instrumentation / Q000379:methods; D017079:Exercise Tolerance; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000175:diagnosis / Q000000981:diagnostic imaging*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain