title: Changes of ventricular and peripheral performance in patients with heart failure and normal ejection fraction: insights from ergometry stress echocardiography.
abstract: OBJECTIVE
  We assessed the left ventricular (LV) and peripheral performance at rest and during exercise in healthy and heart failure subjects with normal ejection fraction (HFNEF) or with reduced ejection fraction (HFREF).
  
  
  METHODS
  All subjects received echocardiography at rest and with bicycle Ergometer exercise. The exercise images for two-dimensional speckle tracking were acquired with submaximal heart rate of 90-100 beats/min, while images for M-mode and tissue Doppler imaging were stored with attainment of >85% of predicted heart rate.
  
  
  RESULTS
  A total of 80 HFNEF, 50 HFREF and 50 controls were studied. There was progressive decrease of two-dimensional global circumferential, radial and longitudinal strains (GCS, GRS and GLS), M-mode and tissue Doppler imaging long-axis parameters from controls, HFNEF to HFREF patients (all P < 0.05) at rest and on exercise. The degree of exercise-induced, long-axis augmentation (GLS and M-mode long axis excursion) decreased progressively from controls, HFNEF to HFREF subjects (all P < 0.05), while the increase in GCS and GRS was similar in all groups. The ventricular-arterial coupling ratio did not change in HFREF but reduced in HFNEF and controls during exercise (P < 0.01). All subjects had a similar resting heart rate, but patients exhibited chronotropic non-competence during exercise (P < 0.001).
  
  
  CONCLUSIONS
  Ventricular and peripheral dysfunction was evident in HFNEF at rest and deteriorated during exercise. The HFNEF patients had significantly impaired long-axis augmentation at stress that was intermediate between HFREF patients and controls. These findings have relevance to generation of symptoms on exercise in both HFNEF and HFREF.
authors.affiliation: Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, S.H. Ho Cardiovascular Disease and Stroke Centre, and 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
authors.initials: G
authors.lastname: Wai-Kwok Yip
authors.forename: John E
authors.initials: JE
authors.lastname: Sanderson
authors.forename: Pui-Wai
authors.initials: PW
authors.lastname: Lee
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: Yat-Yin
authors.initials: YY
authors.lastname: Lam
mesh_terms: D000368:Aged; D001794:Blood Pressure; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D014655:Vascular Resistance; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: HFNEF; Left ventricular function; Peripheral performance; Stress echocardiography