title: Value of exercise echocardiography in heart failure with preserved ejection fraction: a substudy from the KaRen study.
abstract: BACKGROUND
  KaRen is a multicentre study designed to characterize and follow patients with heart failure and preserved ejection fraction (HFpEF). In a subgroup of patients with clinical signs of congestion but left ventricular ejection fraction (LVEF) >45%, we sought to describe and analyse the potential prognostic value of echocardiographic parameters recorded not only at rest but also during a submaximal exercise stress echocardiography. Exercise-induced changes in echo parameters might improve our ability to characterize HFpEF patients.
  
  
  RESULTS
  Patients were prospectively recruited in a single tertiary centre following an acute HF episode with NT-pro-BNP >300 pg/mL (BNP > 100 pg/mL) and LVEF > 45% and reassessed by exercise echo-Doppler after 4-8 weeks of dedicated treatment. Image acquisitions were standardized, and analysis made at end of follow-up blinded to patients' clinical status and outcome. In total, 60 patients having standardized echocardiographic acquisitions were included in the analysis. Twenty-six patients (43%) died or were hospitalized for HF (primary outcome). The mean ± SD workload was 45 ± 14 watts (W). Mean ± SD resting LVEF and LV global longitudinal strain was 57.6 ± 9.5% and -14.5 ± 4.2%, respectively. Mean ± SD resting E/e' was 11.3 ± 4.7 and 13.1 ± 5.3 in those patients who did not and those who did experience the primary outcome, respectively (P = 0.03). Tricuspid regurgitation (TR) peak velocity during exercise were 3.3 ± 0.5 and 3.7 ± 0.5 m/s (P = 0.01). Exercise TR was independently associated with HF-hospitalization or death after adjustment on baseline clinical and biological characteristics.
  
  
  CONCLUSIONS
  Exercise echocardiography may contribute to identify HFpEF patients and especially high-risk ones. Our study suggested a prognostic value of TR recorded during an exercise. That was demonstrated independently of the value of resting E/e'.
authors.affiliation: Cardiologie, CHU Rennes, Rennes, France CIC-IT 804, LTSI INSERM 1099, Université Rennes-1, Hôpital Pontchaillou, rue Henri Le Guillou, F-35000 Rennes, France erwan.donal@chu-rennes.fr.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.affiliation: Pharmacologie Clinique et CIC-IP 0203, CHU Rennes et Université Rennes-1, Rennes, France.
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lund
authors.affiliation: Karolinska University Hospital Stockholm, Solna, Sweden.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
authors.affiliation: CIC-IT 804, LTSI INSERM 1099, Université Rennes-1, Hôpital Pontchaillou, rue Henri Le Guillou, F-35000 Rennes, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Reynaud
authors.affiliation: CIC-IT 804, LTSI INSERM 1099, Université Rennes-1, Hôpital Pontchaillou, rue Henri Le Guillou, F-35000 Rennes, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Schnell
authors.affiliation: Danderyds Hospital, Stockholm, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Persson
authors.affiliation: Cellule recherche clinique et registres, Société Française de Cardiologie et URC Paris Est, Paris, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Drouet
authors.affiliation: Pharmacologie Clinique et CIC-IP 0203, CHU Rennes et Université Rennes-1, Rennes, France.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Linde
authors.affiliation: Cardiologie, CHU Rennes, Rennes, France CIC-IT 804, LTSI INSERM 1099, Université Rennes-1, Hôpital Pontchaillou, rue Henri Le Guillou, F-35000 Rennes, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Daubert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D025401:Echocardiography, Stress / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D045283:Natriuretic Agents / Q000097:blood; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume
chemical_list: D015415:Biomarkers; D045283:Natriuretic Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Echocardiography; Heart failure with preserved ejection fraction; Right ventricle; Strain