The online version of this article (doi:10.1186/1476-7120-10-36) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional capacity assessed by 6 min walk test (6-MWT) in patients with heart failure (HF), irrespective of ejection fraction (EF).
In 147 HF patients (mean age 61 ± 11 years, 50.3% male), a 6-MWT and an echo-Doppler study were performed in the same day. Global LV dyssynchrony was indirectly assessed by total isovolumic time - t-IVT [in s/min; calculated as: 60 – (total ejection time + total filling time)], and Tei index (t-IVT/ejection time). Patients were divided into two groups based on the 6-MWT distance (Group I: ≤300 m and Group II: >300 m), and also in two groups according to EF (Group A: LVEF ≥ 45% and Group B: LVEF < 45%).
In the cohort of patients as a whole, the 6-MWT correlated with t-IVT (r = −0.49, p < 0.001) and Tei index (r = −0.43, p < 0.001) but not with any of the other clinical or echocardiographic parameters. Group I had lower hemoglobin level (p = 0.02), lower EF (p = 0.003), larger left atrium (p = 0.02), thicker interventricular septum (p = 0.02), lower A wave (p = 0.01) and lateral wall late diastolic myocardial velocity a’ (p = 0.047), longer isovolumic relaxation time (r = 0.003) and longer t-IVT (p = 0.03), compared with Group II. In the patients cohort as a whole, only t-IVT ratio [1.257 (1.071-1.476), p = 0.005], LV EF [0.947 (0.903-0.993), p = 0.02], and E/A ratio [0.553 (0.315-0.972), p = 0.04] independently predicted poor 6-MWT performance (<300 m) in multivariate analysis. None of the echocardiographic measurements predicted exercise tolerance in HFpEF.
In patients with HF, the limited exercise capacity, assessed by 6-MWT, is related mostly to severity of global LV dyssynchrony, more than EF or raised filling pressures. The lack of exercise predictors in HFpEF reflects its multifactorial pathophysiology.
Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O'Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y: American heart association statistics committee and stroke statistics subcommittee. heart disease and stroke statistics-2009 update: a report from the American heart association statistics committee and stroke statistics subcommittee. Circulation. 2009, 119: 480-6. CrossRefPubMed
Davies M, Hobbs F, Davis R, Kenkre J, Roalfe AK, Hare R, Wosornu D, Lancashire RJ: Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study. Lancet. 2001, 358: 439-45. 10.1016/S0140-6736(01)05620-3 CrossRefPubMed
Ciampi Q, Pratali L, Porta MD, Petruzziello B, Manganiello V, Villari B, Picano E, Sicari R: Tissue Doppler systolic velocity change during dobutamine stress echocardiography predicts contractile reserve and exercise tolerance in patients with heart failure. Eur Heart J Cardiovasc Imaging. 2012, [Epub ahead of print].
Gardin JM, Leifer ES, Fleg JL, Whellan D, Kokkinos P, Leblanc MH, Wolfel E, Kitzman DW: HF-ACTION Investigators. Relationship of Doppler-Echocardiographic left ventricular diastolic function to exercise performance in systolic heart failure: the HF-ACTION study. Am Heart J. 2009, 158: S45-52. 10.1016/j.ahj.2009.07.015 CrossRefPubMedPubMedCentral
Leong DP, Grover S, Molaee P, Chakrabarty A, Shirazi M, Cheng YH, Penhall A, Perry R, Greville H, Joseph MX, Selvanayagam JB: Nonvolumetric echocardiographic indices of right ventricular systolic function: validation with cardiovascular magnetic resonance and relationship with functional capacity. Echocardiography. 2012, 29: 455-63. 10.1111/j.1540-8175.2011.01594.x CrossRefPubMed
Rubis P, Podolec P, Tomkiewicz-Pajak L, Kopec G, Olszowska M, Tracz W: Usefulness of the evaluation of isovolumic and ejection phase myocardial signals during stress echocardiography in predicting exercise capacity in heart failure patients. Echocardiography. 2009, 26: 1050-9. 10.1111/j.1540-8175.2009.00922.x CrossRefPubMed
Conraads VM, Metra M, Kamp O, De Keulenaer GW, Pieske B, Zamorano J, Vardas PE, Böhm M, Dei Cas L: Effects of the long-term administration of nebivolol on the clinical symptoms, exercise capacity, and left ventricular function of patients with diastolic dysfunction: results of the ELANDD study. Eur J Heart Fail. 2011, [Epub ahead of print].
Grundtvig M, Gullestad L, Hole T, Flønæs B, Westheim A: Characteristics, implementation of evidence-based management and outcome in patients with chronic heart failure: results from the Norwegian heart failure registry. Eur J Cardiovasc Nurs. 2011, 10: 44-9. 10.1016/j.ejcnurse.2010.04.001 CrossRefPubMed
Bajraktari G, Dini FL, Fontanive P, Elezi S, Berisha V, Napoli AM, Ciuti M, Henein M: Independent and incremental prognostic value of Doppler-derived left ventricular total isovolumic time in patients with systolic heart failure. Int J Cardiol. 2011, 148: 271-5. 10.1016/j.ijcard.2009.09.567 CrossRefPubMed
Cleland JG, Coletta AP, Yassin A, Buga L, Torabi A, Clark AL: Clinical trials update from the European Society of Cardiology Meeting 2009: AAA, RELY, PROTECT, ACTIVE-I, European CRT survey, German pre-SCD II registry, and MADIT-CRT. Eur J Heart Fail. 2009, 11: 1214-9. 10.1093/eurjhf/hfp162 CrossRefPubMed
Hunt SA, Abraham WT, Chin MH: ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005, 112: e154-235. 10.1161/CIRCULATIONAHA.105.167586 CrossRefPubMed
Gottdiener JS, Bednarz J, Devereux R: American Society of Echocardiography. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr. 2004, 17: 1086-119. PubMed
Crapo RO, Casaburi R, Coates AL, Enright PL, MacIntyre NR, McKay RT, Johnson D, Wanger JS, Zeballos RJ, Bittner V, Mottram C: ATS Statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002, 166: 1111-1117.
Rostagno C, Olivo G, Comeglio M, Boddi V, Banchelli M, Galanti G, Gensini GF: Prognostic value of 6-min walk corridor test in patients with mild to moderate heart failure: comparison with other methods of functional evaluation. Eur J Heart Fail. 2003, 5 (3): 247-52. 10.1016/S1388-9842(02)00244-1 CrossRefPubMed
Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, Tajik AJ, Seward JB: New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function - a study in normals and dilated cardiomyopathy. J Cardiol. 1995, 26: 357-366. PubMed
Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ: American Society of Echocardiography. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003, 16: 777-802. 10.1016/S0894-7317(03)00335-3 CrossRefPubMed
Gardin JM, Adams DB, Douglas PS, Feigenbaum H, Forst DH, Fraser AG, Grayburn PA, Katz AS, Keller AM, Kerber RE, Khandheria BK, Klein AL, Lang RM, Pierard LA, Quinones MA, Schnittger I: American Society of Echocardiography. Recommendations for a standardized report for adult transthoracic echocardiography: a report from the American Society of Echocardiography’s Nomenclature and Standards Committee and Task Force for a Standardized Echocardiography Report. J Am Soc Echocardiogr. 2002, 15: 275-90. 10.1067/mje.2002.121536 CrossRefPubMed
Guyatt GH, Thompson PJ, Berman LB, Sullivan MJ, Townsend M, Jones NL, Pugsley SO: How should we measyre function in patients with chronic heart and lung disease?. J Chronic Dis. 1985, 28: 517-24. CrossRef
Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, Abraham WT, Ghio S, Leclercq C, Bax JJ, Yu CM, Gorcsan J, St John Sutton M, De Sutter J, Murillo J: Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation. 2008, 117: 2608-16. 10.1161/CIRCULATIONAHA.107.743120 CrossRefPubMed
Ritzema JL, Richards AM, Crozier IG, Frampton CF, Melton IC, Doughty RN, Stewart JT, Eigler N, Whiting J, Abraham WT, Troughton RW: Serial Doppler echocardiography and tissue Doppler imaging in the detection of elevated directly measured left atrial pressure in ambulant subjects with chronic heart failure. JACC Cardiovasc Imaging. 2011, 4: 927-34. 10.1016/j.jcmg.2011.07.004 CrossRefPubMed
Kuppahally SS, Michaels AD, Tandar A, Gilbert EM, Litwin SE, Bader FM: Can echocardiographic evaluation of cardiopulmonary hemodynamics decrease right heart catheterizations in end-stage heart failure patients awaiting transplantation?. Am J Cardiol. 2010, 106: 1657-62. 10.1016/j.amjcard.2010.07.022 CrossRefPubMed
- Left ventricular markers of global dyssynchrony predict limited exercise capacity in heart failure, but not in patients with preserved ejection fraction
Michael Y Henein
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II