title: Functional and hemodynamic cardiac determinants of exercise capacity in patients with systolic heart failure.
abstract: Decreased exercise capacity is the main symptom in patients with heart failure (HF). We assessed the association among noninvasively determined maximal cardiac output at exercise, systolic and diastolic cardiac functions at rest, and peak oxygen uptake (pVo(2)) exercise capacity in patients with congestive HF. We studied 102 patients 62 ± 11 years of age with New York Heart Association class II to IV stable HF and left ventricular (LV) ejection fraction <45%. All patients underwent echocardiography and a treadmill cardiopulmonary exercise test for evaluation of pVo(2) corrected for fat-free mass. During the cardiopulmonary exercise test, cardiac output was estimated noninvasively and continuously using Nexfin HD. Fat-free mass-corrected pVo(2) was associated in an univariate linear regression analysis with peak exercise cardiac index (CI) (beta 0.511, p <0.001), LV end-diastolic pressure estimates (peak early diastolic filling velocity/early diastolic tissue velocity [E/e'], beta -0.363, p = 0.001), and right ventricular function (tricuspid annular plane systolic excursion, beta 0.393, p <0.001). In multivariate analysis peak exercise CI (beta 0.380, p = 0.001), but not cardiac output or LV ejection fraction at rest, was an independent predictor of pVo(2). Other independent predictors of pVo(2) were E/e' (beta -0.276, p = 0.009) and tricuspid annular plane systolic excursion (beta 0.392, p <0.001), also when adjusted for age and gender. In conclusion, peak CI is an independent predictor of fat-free mass-corrected pVo(2) in patients with systolic HF. Of all echocardiographic parameters at rest, right ventricular function and E/e' were independently and significantly associated with pVo(2), whereas LV ejection fraction at rest was not.
authors: Department of Cardiology, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands.
authors: Yoran M
authors: YM
authors: Hummel
authors: Silvia
authors: S
authors: Bugatti
authors: Kevin
authors: K
authors: Damman
authors: Suzan
authors: S
authors: Willemsen
authors: Jasper W L
authors: JW
authors: Hartog
authors: Marco
authors: M
authors: Metra
authors: Johannes S
authors: JS
authors: Sipkens
authors: Dirk J
authors: DJ
authors: van Veldhuisen
authors: Adriaan A
authors: AA
authors: Voors
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002302:Cardiac Output / Q000502:physiology*; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D005080:Exercise Test / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D054143:Heart Failure, Systolic / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000534:rehabilitation*; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D013844:Thiazoles / Q000627:therapeutic use
chemical_list: D013844:Thiazoles; C406794:alagebrium