title: Heart failure with a preserved ejection fraction additive value of an exercise stress echocardiography.
abstract: BACKGROUND
  Heart failure (HF) with a preserved (P) left ventricular (LV) ejection fraction (EF) is common, though its diagnosis and physiopathology remains unclear. We sought to analyse the myocardial characteristics at rest and during a sub-maximal exercise test in patients with HFPEF.
  
  
  RESULTS
  Standardized sub-maximal exercise stress echocardiography was performed in (i) 21 patients from the Karolinska Rennes Prospective Study of Heart Failure with Preserved Left Ventricular Ejection Fraction HFPEF registry, whose LVEF was ≥45% and (ii) 15 control patients free of any manifestations of HF. During a sub-maximal exercise test, LV systolic function measured as a global four-chamber longitudinal strain was -17±5% in patients with HFPEF vs. -22±4% in controls (P<0.001), LV longitudinal diastolic relaxation, expressed as e' (septal and lateral walls averaged) was 9±2 cm/s in patients vs. 15±4 cm/s in controls (P<0.001), and RV longitudinal systolic function, expressed as RV s', was 14±3 cm/s in patients vs. 18±1 cm/s in controls (P=0.03). LV afterload (arterial elastance) was 2.7±1 mmHg/mL and was correlated with a decrease in LV longitudinal strain (R=0.51, P<0.01) during exercise.
  
  
  CONCLUSIONS
  The assessment of longitudinal systolic and diastolic LV and RV functions is valuable during a sub-maximal exercise stress echocardiography to confirm the heart dysfunction related to the HFPEF symptoms. It might be used as a diagnostic test for difficult clinical situations. ClinicalTrials.gov identifier: NCT01091467.
authors.affiliation: Department of Cardiology, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35033 Rennes, France. erwan.donal@chu-rennes.fr
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.forename: Christophe
authors.initials: C
authors.lastname: Thebault
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lund
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Kervio
authors.forename: Amelie
authors.initials: A
authors.lastname: Reynaud
authors.forename: Tabasomne
authors.initials: T
authors.lastname: Simon
authors.forename: Elodie
authors.initials: E
authors.lastname: Drouet
authors.forename: Emilie
authors.initials: E
authors.lastname: Nonotte
authors.forename: Cecilia
authors.initials: C
authors.lastname: Linde
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Daubert
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries