Abstract 13981: Left Ventricular Mass Predicts Hemodynamic Indices of Cardiovascular Reserve Capacity during Exercise
Introduction: Increased left ventricular mass (LVM) is an easily quantifiable risk factor for future development of heart failure. We hypothesized that LVM would predict hemodynamic (HD) and gas exchange measurements indicative of cardiac reserve capacity in patients with normal resting LV filling pressures (PCWP ≤ 15mmHg) undergoing evaluation of dyspnea on exertion.
Methods: 275 patients referred to the Massachusetts General Hospital for maximal incremental CPET with invasive HD monitoring were studied. Resting echocardiography was performed within 1 year of CPET to determine LVM and relative wall thickness by standard 2-D ASE formulas.
Results: Of the subjects studied (age: 58±16; male: 55%; BMI 30±6.8; LVEF: 0.62±0.11; mean±SD), 65 (24%) were determined to have LV hypertrophy (LVH). PCWP at rest did not differ according to whether LVH was present. However, at 30W subjects with LVH had significantly higher PCWP than subjects without LVH (Figure). There was a linear increment in PCWP vs. CO during exercise that was significantly steeper in subjects with LVH vs. without LVH (3.2±0.3 vs. 2.1±0.1 mmHg/L/min; p<0.005). Log LVM index (LVM/height2.7) was related to PCWP@30W (β = 0.37) and inversely related to peak VO2 (β = –0.36), aerobic efficiency (β = –0.18), and CO augmentation (β = –0.17), all p<0.005. These associations were preserved in regression models adjusted for age, sex, BMI, and LVEF.
Conclusions: These results demonstrate that LV filling pressure increments significantly more with exercise in individuals with greater LVM, independent of age, sex, BMI, or LVEF. These changes are associated with prognostic indices of cardiorespiratory fitness, suggesting that LVH predicts abnormal hemodynamic responses to exercise even when resting filling pressures are normal. Targeting early changes in LVM may favorably affect functional capacity in individuals with dyspnea.
Author Disclosures: A.S. Eisman: None. R.V. Shah: None. A.E. Dress: None. R.S. Vasan: None. G.D. Lewis: None.
- © 2014 by American Heart Association, Inc.