title: Quantification of left ventricular performance in different heart failure phenotypes by comprehensive ergometry stress echocardiography.
abstract: BACKGROUND
  We evaluated the left ventricular (LV) performance in patients with heart failure and preserved ejection fraction (HFPEF) during exercise as compared to those with heart failure and reduced ejection fraction (HFREF) and healthy subjects.
  
  
  METHODS
  All subjects received echocardiographic (Vivid7, GE Healthcare) examination with symptom-limited exercise testing on a semi-recumbent and tilting bicycle ergometer (Lode BV, Netherlands). The exercise images for 2-dimensional (2D) speckle tracking were acquired with heart rate of 90-100 bpm, while exercise images for tissue Doppler imaging (TDI) and M-mode echocardiography were stored with attainment of >85% of maximal age-predicted heart rate.
  
  
  RESULTS
  Stress echocardiographic examinations were performed in 40 HFPEF (aged 65 ± 9 years; 53% male), 40 HFREF (aged 62 ± 9 years; 90% male) and 30 normal controls (aged 56 ± 5 years; 33% male). Trends of progressive decline in 2D global longitudinal, circumferential and radial strains (GLS, GCS and GRS); TDI septal s' and Sm; and M-mode mitral annular plane systolic excursion (MAPSE) were observed from control, HFPEF to HFREF groups (p<0.05 for all). LV twist was preserved in HFPEF but reduced in HFREF patients as compared to normal controls (p<0.05). Diastolic function measured by TDI septal e', Em and septal E/e' progressively decreased from controls, HFPEF to HFREF patients (all p<0.05). Stroke volumes and cardiac indices (LVSI & LVCI) were preserved in HFPEF but deteriorated in HFREF than controls.
  
  
  CONCLUSIONS
  This study provides the reference values of LV performance during exercise in HFPEF and knowledge about these changes provide important insights for future clinical studies.
authors.affiliation: Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, S.H. Ho Cardiovascular Disease and Stroke Centre, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
authors.forename: Gabriel Wai-Kwok
authors.initials: GW
authors.lastname: Yip
authors.forename: John E
authors.initials: JE
authors.lastname: Sanderson
authors.forename: Wei
authors.initials: W
authors.lastname: Feng
authors.forename: Jun-Min
authors.initials: JM
authors.lastname: Xie
authors.forename: Xiu-Xia
authors.initials: XX
authors.lastname: Luo
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
authors.forename: Yat-Yin
authors.initials: YY
authors.lastname: Lam
mesh_terms: D000368:Aged; D015331:Cohort Studies; D025401:Echocardiography, Stress / Q000379:methods / Q000592:standards*; D016552:Ergometry / Q000379:methods / Q000592:standards*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D010865:Pilot Projects; D011446:Prospective Studies; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: HFPEF; HFREF; Left ventricular performance; Stress echocardiography