Abstract 19035: Exercise Intolerance in Heart Failure Patients With Preserved Ejection Fraction (HFpEF) - Not Only a Diastolic Problem
Introduction: Potential mechanisms of exercise intolerance in HFpEF patients were investigated.
Hypothesis: We hypothesized that HFpEF patients have reduced capacity to increase left ventricular (LV) cardiac output (CO) during exercise due to subendocardial (longitudinal) dysfunction. Patients were compared to healthy controls (C) by three-dimensional speckle tracking echocardiography.
Methods: Thirteen patients and 5 age matched controls (age: 74 ± 5 (SD) and 69 ± 6 years, respectively, p=NS) were compared. All were examined with 2D and 3D echo at baseline and immediately after ergometric testing until exhaustion. Left ventricular diastolic function was assessed by transmitral flow velocities (E and A) and average of tissue velocities from basal septal and lateral walls by Doppler (e’). LV systolic measures including EF, cardiac output, peak systolic flow rate (time derivative of 3D volume trace normalized to end-diastolic volume) and peak systolic longitudinal and circumferential global strains (LS and CS, respectively) were obtained.
Results: Table 1 summarizes results at baseline and after exercise. As predicted, impaired filling was detected in the HFpEF group. There were no differences in systolic measures between HFpEF and C at baseline (Table 1). During exercise, HFpEF patients were unable to increase their cardiac output and peak systolic flow rate. A concomitant reduction of systolic longitudinal strain was observed while circumferential strain was unchanged (Figure 1, arrow).
Conclusion: In conclusion, exercise intolerance in HFpEF patients may be explained by subendocardial dysfunction that was revealed during ergometric testing.
Author Disclosures: G. Kunszt: None. S. Aakhus: None. S. Urheim: None.
- © 2014 by American Heart Association, Inc.