Background
Methods
Study population
Data collection
Echocardiographic examination
Measurement of amino-terminal pro BNP
Six minute walk test
Statistical analysis
Results
Patients with Limited vs. Good 6 MWT performance (Table 1)
Variable | All patients | 6MWT > 300 m | 6MWT ≤ 300 m |
P value |
---|---|---|---|---|
(n = 111) | (n = 70) | (n = 41) | ||
Clinical and biochemical data | ||||
Age (years) | 63 ± 10 | 61 ± 10 | 66 ± 9 | 0.008 |
Female (%) | 47 | 41 | 56 | 0.135 |
Smoking (%) | 31.5 | 30 | 34 | 0.676 |
Diabetes (%) | 28 | 20 | 41 | 0.027 |
Arterial hypertension (%) | 69.4 | 68.6 | 70.7 | 0.835 |
Waist/hips ratio | 0.97 ± 0.06 | 0.96 ± 0.06 | 0.98 ± 0.05 | 0.064 |
BMI (kg/m2) | 28.6 ± 4.1 | 28.7 ± 4.2 | 28.4 ± 3.8 | 0.764 |
BSA (m2) | 1.13 ± 0.2 | 1.15 ± 0.1 | 1.08 ± 0.1 | 0.067 |
Fasting glucose (mmol/L) | 6.8 ± 2.8 | 6.4 ± 2.4 | 7.9 ± 2.9 | 0.009 |
Total cholesterol (mmol/L) | 4.9 ± 1.2 | 4.9 ± 1.1 | 4.8 ± 1.2 | 0.439 |
Triglycerides (mmol/L) | 1.7 ± 0.7 | 1.7 ± 0.7 | 1.6 ± 0.8 | 0.747 |
Creatinine (μmol/L) | 96 ± 46 | 98 ± 56 | 93 ± 21 | 0.527 |
Hemoglobin (g/dl) | 12.7 ± 1.8 | 12.8 ± 1.6 | 12.3 ± 2.0 | 0.166 |
NT-ProBNP (pg/mL | 1178 ± 1635 | 970 ± 1286 | 1534 ± 2072 | 0.124 |
Baseline heart rate (beats/min) | 74 ± 16 | 71 ± 15 | 80 ± 13 | 0.004 |
Echocardiographic data | ||||
Ejection fraction (%) | 47 ± 15 | 48 ± 14 | 45 ± 15 | 0.409 |
IVSd (cm) | 1.1 ± 0.2 | 1.1 ± 0.2 | 1.11 ± 0.1 | 0.923 |
Left atrium (cm) | 4.4 ± 0.8 | 4.2 ± 0.7 | 4.8 ± 0.9 | 0.001 |
LV EDD (cm) | 5.8 ± 1.0 | 5.7 ± 0.8 | 5.9 ± 1.1 | 0.319 |
LV ESD (cm) | 4.4 ± 1.2 | 4.2 ± 1.1 | 4.5 ± 1.3 | 0.281 |
Lateral MAPSE (cm) | 1.15 ± 0.4 | 1.2 ± 0.4 | 1.05 ± 0.3 | 0.051 |
Septal MAPSE (cm) | 1.0 ± 0.3 | 1.0 ± 0.3 | 0.9 ± 0.2 | 0.054 |
TAPSE (cm) | 2.15 ± 0.5 | 2.2 ± 0.4 | 2.1 ± 0.5 | 0.466 |
LVPWd (cm) | 1.05 ± 0.15 | 1.05 ± 0.2 | 1.05 ± 0.1 | 0.960 |
LVM (g) | 266 ± 85 | 260 ± 75 | 279 ± 101 | 0.324 |
LVMI (g/m2.7) | 58 ± 21 | 53 ± 16 | 67 ± 26 | 0.006 |
E/A ratio | 1.05 ± 0.7 | 1.0 ± 0.7 | 1.1 ± 0.8 | 0.414 |
E wave DT | 174 ± 49 | 178 ± 50 | 167 ± 44 | 0.228 |
Filling time (ms) | 414 ± 132 | 434 ± 141 | 376 ± 104 | 0.019 |
IVRT (ms) | 126 ± 41 | 131 ± 42 | 110 ± 34 | 0.037 |
PA acceleration time (ms) | 110 ± 24 | 114 ± 23 | 100 ± 21 | 0.006 |
E/e’ ratio | 11 ± 5.9 | 10 ± 4.1 | 13 ± 8.0 | 0.053 |
Lateral e’ (cm/s) | 6.1 ± 2.1 | 6.1 ± 2.4 | 6.0 ± 2.6 | 0.817 |
Lateral a’(cm/s) | 7.9 ± 3.6 | 8.1 ± 3.7 | 7.5 ± 3.5 | 0.461 |
Lateral s’ (cm/s) | 5.3 ± 1.6 | 5.5 ± 1.5 | 4.9 ± 1.6 | 0.101 |
Septal e’ (cm/s) | 4.9 ± 2.2 | 5.1 ± 2.2 | 4.6 ± 2.1 | 0.312 |
Septal a’ (cm/s) | 7.15 ± 2.3 | 7.5 ± 2.4 | 6.4 ± 1.8 | 0.018 |
Septal s’ (cm/s) | 4.4 ± 1.5 | 4.6 ± 1.6 | 4.0 ± 1.0 | 0.023 |
Right e’ (cm/s) | 8.7 ± 3.0 | 8.9 ± 3.1 | 8.3 ± 2.7 | 0.305 |
Right a’ (cm/s) | 12.5 ± 4.4 | 12.7 ± 4.3 | 11.8 ± 4.3 | 0.333 |
Right s’ (cm/s) | 8.8 ± 3.0 | 9.8 ± 2.8 | 8.0 ± 3.2 | 0.086 |
LAV max (ml) | 73 ± 35 | 68 ± 26 | 80 ± 47 | 0.218 |
LAV min (ml) | 40 ± 29 | 35 ± 20 | 49 ± 38 | 0.067 |
LA EF (%) | 47 ± 18 | 49 ± 17 | 45 ± 16 | 0.314 |
Patients with HFpEF vs. HFrEF (Table 2)
Variable | HFpEF | HFrEF |
P value |
---|---|---|---|
(n = 55) | (n = 56) | ||
Clinical and biochemical data | |||
Age (years) | 63 ± 6.8 | 62 ± 12 | 0.767 |
Body-mass index (kg/m2) | 29 ± 4 | 28 ± 3.6 | 0.130 |
Waist/hips ratio | 0.96 ± 0.06 | 0.96 ± 0.06 | 0.996 |
Fasting glucose (mmol/L) | 7.1 ± 3.1 | 6.7 ± 2.3 | 0.462 |
Total cholesterol (mmol/L) | 5.1 ± 1.1 | 4.7 ± 1.1 | 0.054 |
Triglycerides (mmol/L) | 1.8 ± 0.7 | 1.5 ± 0.7 | 0.137 |
Creatinine (μmol/L) | 87 ± 16 | 105 ± 63 | 0.052 |
Hemoglobin (g/dL) | 12.8 ± 1.9 | 12.4 ± 1.5 | 0.078 |
Baseline heart rate (beats/min) | 70 ± 15 | 79 ± 15 | 0.005 |
NT-ProBNP (pg/mL) | 681 ± 1280 | 1665 ± 1801 | 0.001 |
6-min walk distance (m) | 339 ± 106 | 282 ± 119 | 0.010 |
PPV of 6-min walk distance (%) | 56 ± 19 | 45 ± 20 | 0.004 |
Echocardiographic data | |||
IVSd (cm) | 1.1 ± 0.1 | 1.1 ± 0.2 | 0.666 |
Left atrium (cm) | 4.2 ± 0.8 | 4.6 ± 0.7 | 0.004 |
LV EDD (cm) | 5.2 ± 0.7 | 6.3 ± 0.9 | <0.001 |
LV ESD (cm) | 3.5 ± 0.7 | 5.1 ± 1 | <0.001 |
EDV (ml) | 135 ± 44 | 213 ± 67 | <0.001 |
ESV (ml) | 56 ± 8.7 | 140 ± 52 | <0.001 |
LV EF (%) | 59.6 ± 8.7 | 35 ± 7.5 | <0.001 |
Lateral MAPSE (cm) | 1.27 ± 0.3 | 1.02 ± 0.4 | 0.001 |
Septal MAPSE (cm) | 1.14 ± 0.2 | 0.85 ± 0.2 | <0.001 |
TAPSE (cm) | 2.3 ± 0.4 | 2.1 ± 0.5 | 0.062 |
LVPWd (cm) | 1.05 ± 0.2 | 1.06 ± 0.2 | 0.688 |
E/A ratio | 0.81 ± 0.3 | 1.3 ± 0.9 | 0.001 |
LVM (g) | 224 ± 69 | 310 ± 77 | <0.001 |
LVMI (g/m2.7) | 50 ± 16 | 67 ± 23 | <0.001 |
E wave DT | 189 ± 44 | 159 ± 49 | 0.002 |
Filling time (ms) | 454 ± 147 | 372 ± 99 | 0.001 |
IVRT (ms) | 122 ± 39 | 130 ± 43 | 0.407 |
PA acceleration time (ms) | 118 ± 20 | 101 ± 23 | <0.001 |
E/e’ ratio | 9.4 ± 4.7 | 13.5 ± 6.4 | 0.001 |
Lateral e’ (cm/s) | 6.7 ± 2.6 | 5.3 ± 2.2 | 0.009 |
Lateral a’ (cm/s) | 8.6 ± 3.3 | 7.1 ± 3.8 | 0.051 |
Lateral s’ (cm/s) | 5.7 ± 1.3 | 4.8 ± 1.7 | 0.006 |
Septal e’ (cm/s) | 5.7 ± 2.5 | 4.0 ± 1.1 | <0.001 |
Septal a’ (cm/s) | 7.9 ± 2.1 | 6.2 ± 2.0 | <0.001 |
Septal s’ (cm/s) | 4.9 ± 1.6 | 3.8 ± 0.9 | <0.001 |
Right e’ (cm/s) | 9.4 ± 3.2 | 7.9 ± 2.4 | 0.012 |
Right a’ (cm/s) | 12.7 ± 4.5 | 12.2 ± 4.2 | 0.593 |
Right s’ (cm/s) | 9.1 ± 3.1 | 8.3 ± 2.7 | 0.187 |
LAV max
| 62 ± 23 | 83 ± 57 | 0.005 |
LAV min
| 29 ± 18 | 51 ± 34 | <0.001 |
LA EF (%) | 53 ± 15 | 43 ± 18 | 0.012 |
Determinants of limited 6 MWT distance (Table 3)
Variable | OR | (CI 95%) |
P value |
---|---|---|---|
Determinants of all HF study patients | |||
Univariate determinants | |||
Age | 1.062 | (1.014–1.112) | 0.011 |
Diabetes mellitus | 0.353 | (0.150–0.892) | 0.017 |
NYHA class >1 | 0.290 | (0.108–0.783) | 0.015 |
LVMI | 1.035 | (1.011–1.060) | 0.004 |
Left atrium | 2.410 | (1.404–4.137) | 0.001 |
E wave | 1.023 | (1.004–1.043) | 0.019 |
FT | 0.996 | (0.993–1.000) | 0.036 |
Heart rate | 1.039 | (1.010–1.069) | 0.008 |
PAAC | 0.972 | (0.952–0.993) | 0.010 |
E/e’ | 1.092 | (1.009–1.181) | 0.028 |
Septal a’ | 0.786 | (0.631–0.979) | 0.032 |
Septal s’ | 0.661 | (0.444–0.984) | 0.041 |
Multivariate determinants | |||
Left atrium diameter | 2.676 | (1.242–5.766) | 0.012 |
Diabetes mellitus | 0.274 | (0.084–0.898) | 0.033 |
Age | 1.067 | (0.999–1.140) | 0.052 |
NYHA class >1 | 2.068 | (0.859–4.978) | 0.105 |
Gender | 0.406 | (0.122–1.350) | 0.141 |
E/e’ | 1.043 | (0.943–1.153) | 0.415 |
FT | 0.997 | (0.989–1.005) | 0.463 |
Septal s’ | 0.854 | (0.512–1.422) | 0.543 |
Heart rate | 1.011 | (0.940–1.088) | 0.764 |
Determinants in HFpEF patients | |||
Univariate determinants | |||
Diabetes mellitus | 0.276 | (0.082–0.926) | 0.037 |
Haemoglobin | 0.697 | (0.502–0.968) | 0.031 |
NYHA class >1 | 0.206 | (0.043–0.993) | 0.049 |
BSA | 0.005 | (0.000–0.308) | 0.012 |
LVMI | 1.049 | (1.006–1.094) | 0.025 |
Lateral a’ | 0.772 | (0.603–0.987) | 0.039 |
Lateral s’ | 0.489 | (0.270–0.886) | 0.018 |
Multivariate determinants | |||
Lateral s’ | 0.295 | (0.099–0.882) | 0.029 |
Haemoglobin | 0.497 | (0.248–0.998) | 0.049 |
NYHA class >1 | 0.051 | (0.003–1.034) | 0.053 |
BSA | 0.081 | (0.000–6.016) | 0.463 |
Lateral a’ | 1.049 | (0.734–1.500) | 0.793 |
Age | 0.988 | (0.827–1.179) | 0.891 |
Diabetes | 0.860 | (0.109–6.786) | 0.886 |
Determinants in HFrEF patients | |||
Univariate determinants | |||
Age | 1.067 | (1.010–1.127) | 0.020 |
Left atrium | 3.236 | (1.333–7.856) | 0.009 |
LAV max | 1.021 | (1.001–1.042) | 0.045 |
LAV min | 1.029 | (1.003–1.055) | 0.032 |
Multivariate determinants | |||
Age | 1.073 | (1.012–1.137) | 0.018 |
Left atrium diameter | 3.685 | (1.348–10.071) | 0.011 |
Gender | 2.147 | (0.556–8.288) | 0.268 |