Exercise capacity and hemodynamic response during exercise depend on the extent of left ventricular remodeling in patients with HFrEF
K Bratis, G Velissaris, M Pentaris, D Chatzis, N Papaioannou, S Papaioannou, S Mykoniati, Z Morou, I Dena, N Biagkis, S Tomaras, E Panagiotopoulos, I Tsallos, V Stavropoulou, A NtalianisAbstract
Background
Theoretically, left ventricular geometry and size play an important role in the propagation of cardiac output and hemodynamics during exercise in patients with HFrEF.
Purpose
To identify possible associations among left ventricular remodeling (LVR) indices defined by cardiac magnetic resonance imaging (CMR) and parameters derived by exercise right heart catheterization (ERHC) and cardiopulmonary exercise test (CPET).
Methods
Consecutive patients with HFrEF were prospectively included and submitted to CMR, ERHC και CPET. LVR indices were considered the following: i) Remodeling index (RI), ii) left ventricular end diastolic (LVEDV) and systolic volumes (LVESV), iii) left ventricular ejection fraction (LVEF), iv) Sphericity index (SI) and v) Relative wall thickness (RWT). During the 6 min ERHC with cycloergometer in supine position, the pulmonary artery pressure (PAP), the pulmonary capillary wedge pressure (PCWP) and the pulmonary artery oxygen saturation (SvO2) and cardiac output were recorded. Finally, VO2 max, % predicted VO2max, VE/VCO2 slope and OUES were the parameters evaluated during CPET.
Results
In total, 25 patients with HFrEF (mean age: 67±5 έτη, NYHA: 2.3±0.8, LVEF: 30±5%) were recruited. A positive association was found between: a) LVEDV and VO2max, VE/VCO2, OUES, mean PAΡ at rest and peak exercise, b) LVESV and OUES (p= 0.035, r=0.566), c) LVEF and % predicted VO2max mean ΡΑΡ at rest and peak exercise, PCWP at rest, d) RI and % predicted VO2max, SvO2 at rest, e) SI and VO2max, mean PAP, PCWP at peak exercise and SvO2 at peak exercise. An inverse relationship was observed between RWT and VO2max, % predicted VO2max, OUES and mean PAP at rest (Table).
Conclusions
LVR influences exercise capacity and hemodynamics during exercise in patients with HFrEF.For image description, please refer to the figure legend and surrounding text.