Abstract 13152: Reduced Submaximal Exercise Capacity and the Role of Neurohumoral Activation in Patients With Diastolic Dysfunction and Diastolic Heart Failure
Background: There is limited knowledge about factors that contribute to a reduction of exercise capacity in patients with diastolic dysfunction (DD) and diastolic heart failure (DD and elevated filling pressures: DHF). This study investigated the association of neurohumoral activation as well as parameters of diastolic function and submaximal exercise performance in patients with DD and DHF.
Methods: In the DIAST-CHF observational study n=1937 patients with risk factors for chronic heart failure were prospectively included, n=1542 patients were analysed in this analysis (exclusion criteria: LVEF<50% and/or atrial fibrillation). All patients were classified as having normal diastolic function (N), DD and DHF. All patients underwent echocardiography and a 6-minute-walking-test (6-MWT). Data are shown as Mean (± SD).
Results: n=264 (17.1%) had N, n=957 (62.1%) had DD and 321 (20.8%) had DHF. Age 60±7/66±8/69±8 y (N/DD/DHF), female gender 55,3/51,9/61,1 %, LVEF 62,1±6,1/61,7±6/61,4±6,6 %. 6-MWT 570/511/492 m (DD vs. DHF, p=0,015), NT-proBNP 113,6/123,7/244,13pg/ml (DD vs. DHF, p<0,001), MR-proADM 0,54/0,59/0,67 (DD vs. DHF, p<0,001) and MR-proANP 88,7/90,4/129 pmol/l (DD vs. DHF, p<0,001). E/é (8,3 vs. 15.3), E/A (0,84 vs. 0,98), é (5,8 vs. 5,1cm/s), á (10,3 vs. 9,6 cm/s), LAVI (21,9 vs. 28,3 ml/m²) and LVMI (113,6 vs. 122,1 g/m²) all DD vs. DHF (p< 0,001). LVEF (61,7 vs. 61,4%), LVD(ED) (5,8 vs. 5,5 mm) and LVD(ES) (5,5 vs. 5,5 mm) were not significantly different. NT-proBNP and MR-proANP as well as diastolic function parameters (E/A, E/é, é, á) were significantly correlated with the 6-MWT (p<0,001). Multiple Regression analyses revealed that only NT-proBNP (p<0,001) and MR-proADM (p=0,01) were independently associated with the 6-MWT.
Conclusion: Patients with DHF did show inferior submaximal exercise performance and higher neurohumoral activation compared with patients with N and patients with DD. In contrast to parameters of diastolic function neurohumoral activation was independently associated to exercise capacity. This suggests that neurohumoral activation is a major determinant of exercise performance in patients with DD and DHF.
- © 2011 by American Heart Association, Inc.