title: Impacts of mitral E/e' on myocardial contractile motion and synchronicity in heart failure patients with reduced ejection fraction: An exercise-echocardiography study.
abstract: BACKGROUND
  The association between diastolic abnormality and postexercise contractile decompensation is uncertain in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF).
  
  
  OBJECTIVE
  The higher mitral E/annular early diastolic velocity (E/e') is relevant to postexercise regional myocardial contractile maladaptation.
  
  
  METHODS
  Seventy HF patients with LVEF <50 % (56 males, 58 ± 15 years) were studied pre- and postexercise using tissue Doppler echocardiography. We evaluated the mean and standard deviation of systolic myocardial velocity (Sm) and electromechanical delay (Ts) of 12 left ventricular segments, and further analyzed the corresponding changes of septal and posterolateral segments.
  
  
  RESULTS
  The higher mitral E/e' was associated with more blunted heterogeneity of Sm and greater ventricular dyssynchrony after exercise. This is due to the posterolateral wall not being able to increase Sm with exercise to the same degree as the septum (decreased posterolateral/septal Sm ratio). Furthermore, the postexercise aggravated difference of Ts between septum and posterolateral segments leads to more dyssynchronous contraction in the higher E/e' groups. An E/e' ≥10 predicted a postexercise posterolateral/septal Sm ≤ 1 (odds ratio [OR]: 5.8, 95% confidence interval [CI]: 1.5-22.6, P = 0.011), and a difference of Ts between septum and posterolateral segments >65 ms (OR: 64, 95% CI: = 6-651, P < 0.001) in HF patients with reduced LVEF in multivariate analysis.
  
  
  CONCLUSIONS
  The higher mitral E/e'-related postexercise maladaptation of myocardial contractile motion and synchronicity suggests the involvement of systolic abnormality in exercise pathophysiology in HF patients with reduced LVEF.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yi-Chih
authors.initials: YC
authors.lastname: Wang
authors.forename: Chih-Chieh
authors.initials: CC
authors.lastname: Yu
authors.forename: Fu-Chun
authors.initials: FC
authors.lastname: Chiu
authors.forename: Chia-Ti
authors.initials: CT
authors.lastname: Tsai
authors.forename: Ling-Ping
authors.initials: LP
authors.lastname: Lai
authors.forename: Juey-Jen
authors.initials: JJ
authors.lastname: Hwang
authors.forename: Jiunn-Lee
authors.initials: JL
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D016017:Odds Ratio; D010507:Periodicity; D011237:Predictive Value of Tests; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left