title: Association of exercise tolerance with effective arterial elastance obtained noninvasively in patients with exertional dyspnea.
abstract: BACKGROUND
  Ventricular-arterial stiffening is a part of the aging process that is amplified by various comorbidities. It affects normal cardiovascular reserve and limits exercise capacity. The aim of this study was to explore the association of physiologic determinants of ventricular-arterial interaction with exercise capacity in patients referred for exercise echocardiography with exertional dyspnea.
  
  
  METHODS
  A total of 93 patients with exertional dyspnea without chest pain were evaluated using the Bruce protocol. Patients with left ventricular ejection fractions < 50% and those with exercise-induced myocardial ischemia were excluded. Poor exercise tolerance was defined as inability to achieve 8 metabolic equivalents.
  
  
  RESULTS
  Thirty-seven patients (40%) had poor exercise tolerance. These patients were older (mean age, 60 vs 54 years, P = .01), more likely to carry the diagnosis of hypertension (84% vs 41%, P < .01), and more likely to be treated with antihypertensive medications. In multivariate logistic regression analysis, left atrial volume index (P = .04) and arterial elastance (P < .01) were significant predictor of poor exercise capacity, while left ventricular ejection fraction, tissue Doppler indices, and global longitudinal strain were not significant.
  
  
  CONCLUSIONS
  Effective arterial elastance determined noninvasively before stress echocardiography appears to be an independent predictor of exercise tolerance in patients with exertional dyspnea.
authors.affiliation: Division of Cardiology, Mount Sinai St Luke's Hospital, Mt Sinai Health System, New York, New York. Electronic address: earguli@alum.emory.edu.
authors.forename: Edgar
authors.initials: E
authors.lastname: Argulian
authors.affiliation: Division of Cardiology, Mount Sinai St Luke's Hospital, Mt Sinai Health System, New York, New York.
authors.forename: Vikram
authors.initials: V
authors.lastname: Agarwal
authors.affiliation: Division of Cardiology, Mount Sinai St Luke's Hospital, Mt Sinai Health System, New York, New York.
authors.forename: Harikrishna
authors.initials: H
authors.lastname: Makani
authors.affiliation: Division of Cardiology, Mount Sinai St Luke's Hospital, Mt Sinai Health System, New York, New York.
authors.forename: Eyal
authors.initials: E
authors.lastname: Herzog
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mt Sinai Hospital, Mt Sinai Health System, New York, New York.
authors.forename: Farooq A
authors.initials: FA
authors.lastname: Chaudhry
mesh_terms: D000368:Aged; D004417:Dyspnea / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D025401:Echocardiography, Stress; D054459:Elasticity Imaging Techniques; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D059289:Vascular Stiffness / Q000502:physiology*
keywords: Arterial elastance; Stress echocardiography; Stress testing