title: Left ventricular long-axis performance during exercise is an important prognosticator in patients with heart failure and preserved ejection fraction.
abstract: BACKGROUND
  Although many prognostic variables have been reported, the risk stratification of patients with heart failure and preserved ejection fraction (HFPEF) has long been controversial due to considerable discordance. Ergometry stress echocardiography may provide a more clinical relevant evaluation in HFPEF. We aimed at evaluating the prognostic value of echocardiographic parameters during exercise in HFPEF patients.
  
  
  METHODS
  Comprehensive echocardiographic examination with symptom-limited exercise testing on a semi-recumbent and tilting bicycle Ergometer (Lode BV, Groningen, the Netherlands) was performed on 80 consecutive HFPEF patients (aged 66±8years; 64% male). The exercise images for two-dimensional (2D) speckle tracking analysis were acquired with heart rate of 90-100bpm, while exercise images for tissue Doppler imaging (TDI) and M-mode echocardiography were stored with attainment of >85% of maximal age-predicted heart rate. All patients were followed up for 3years after stress echocardiography for all-cause mortality and/or heart failure (HF) hospitalization.
  
  
  RESULTS
  During the follow-up, 43 (54%) patients reached the combined end point: 5 (6%) patients died, and another 38 (48%) patients experienced HF hospitalizations. Univariate predictors were: decreased resting left atrial ejection fraction (LAEF), lower peak heart rate, elevated E/e' ratio, reduced TDI myocardial velocities, and impaired 2D global longitudinal strain (GLS) during exercise. Only impaired GLS (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.67 to 0.91) remained independent after multivariate analysis (p=0.008).
  
  
  CONCLUSIONS
  More than half of the HFPEF patients died or were hospitalized for HF at 3-year follow-up and this was significantly related to impaired left ventricular long-axis function during exercise.
authors.affiliation: Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, 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.affiliation: Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, 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: Fang
authors.initials: F
authors.lastname: Fang
authors.affiliation: Cardiac Medicine Unit, Grantham Hospital, Hong Kong.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Wai-Kwok Yip
authors.affiliation: Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, 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: John E
authors.initials: JE
authors.lastname: Sanderson
authors.affiliation: Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, 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: Wei
authors.initials: W
authors.lastname: Feng
authors.affiliation: Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, 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: Jun-Min
authors.initials: JM
authors.lastname: Xie
authors.affiliation: Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, 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: Xiu-Xia
authors.initials: XX
authors.lastname: Luo
authors.affiliation: Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, 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: Alex Pui-Wai
authors.initials: AP
authors.lastname: Lee
authors.affiliation: Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, 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. Electronic address: yylam@cuhk.edu.hk.
authors.forename: Yat-Yin
authors.initials: YY
authors.lastname: Lam
mesh_terms: D000368:Aged; D015150:Echocardiography, Doppler / Q000639:trends; D005080:Exercise Test / Q000379:methods* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: HFPEF; Left ventricular long-axis function; Prognosis; Stress echocardiography