Author + information
- Received September 14, 2016
- Revision received January 15, 2017
- Accepted March 2, 2017
- Published online October 9, 2017.
- Kenya Kusunose, MD, PhDa,∗∗ (, )
- Hirotsugu Yamada, MD, PhDa,∗ (, )
- Susumu Nishio, RMSb,
- Ayumi Ishii, RNc,
- Yukina Hirata, RMS, PhDb,
- Hiromitsu Seno, MDa,
- Yoshihito Saijo, MDa,
- Takayuki Ise, MD, PhDa,
- Koji Yamaguchi, MD, PhDa,
- Shusuke Yagi, MD, PhDa,
- Takeshi Soeki, MD, PhDa,
- Tetsuzo Wakatsuki, MD, PhDa and
- Masataka Sata, MD, PhDa
- aDepartment of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
- bUltrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
- cDepartment of Nursing, Tokushima University Hospital, Tokushima, Japan
Objectives The aim of this study was to assess the relationship between right ventricular (RV) function during pre-load augmentation and exercise tolerance.
Background Peak oxygen uptake (VO2) is a strong predictor of mortality in chronic heart failure. Cardiac function during pre-load augmentation is an important part of the phenomenon in the evaluation of exercise capacity.
Methods We prospectively performed echocardiographic studies in 68 chronic heart failure patients with cardiopulmonary exercise testing (mean age 60 ± 12 years; 69% male). After resting evaluations, echocardiographic parameters were repeated during leg positive pressure (LPP). Exercise capacity was assessed by peak VO2 in all patients (left ventricular ejection fraction: 43 ± 15%).
Results Patients with severely reduced exercise capacity (peak VO2 <14 ml/kg/min) had significantly lower stroke volume index, left ventricular global longitudinal strain and RV strain and higher filling pressure (E/e’ and pulmonary arterial systolic pressure) than the remainder. Stroke volume index (β = 0.49), global longitudinal strain (β = −0.61), E/e’ (β = −0.32), pulmonary arterial systolic pressure (β = −0.57), and RV strain (β = −0.66) during LPP were independently correlated to peak VO2 (all p < 0.01). RV strain during LPP was the most powerful predictor in identifying patients with severely reduced exercise capacity (cut off value: −17%; sensitivity: 81%; specificity: 88%; areas under the curve: 0.88; p < 0.001) compared with other variables including resting parameters.
Conclusions RV strain during pre-load augmentation correlated independently to peak VO2 and was a powerful predictor in identifying patients with severely reduced exercise capacity.
Dr. Kusunose has received a grant from JSPS Kakenhi (No. 15K19381) and the Japan Heart Foundation Research Grant. Dr. Sata has received grants from JSPS Kakenhi (Nos. 16H05299 and 26248050), and from MEXT KAKENHI (No. 21117007). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 14, 2016.
- Revision received January 15, 2017.
- Accepted March 2, 2017.
- 2017 American College of Cardiology Foundation
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