| Autor: |
Farrell, Robyn M, Sbarbaro, John, Hardin, Kathryn, Tanguay, Melissa, Blodgett, Jasmine, Schoenike, Mark, Cunningham, Thomas, Bailey, Cole S, Wooster, Luke, Lau, Emily, Namasivayam, Mayooran, Shah, Ravi V, Nayor, Matthew G, Ho, Jennifer E, Malhotra, Rajeev, Lewis, Gregory |
| Zdroj: |
Circulation (Ovid); November 2019, Vol. 140 Issue: Supplement 1 pA15081-A15081, 1p |
| Abstrakt: |
Introduction:Exercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF) reflects multi-organ dysfunction characteristic of a systemic disorder. We sought to determine if oxygen uptake (VO2) kinetic patterns may aid in resolution of cardiac-specific impairment during exercise.Hypothesis:Delayed kinetics of VO2recovery will predict cardiac performance and heart failure (HF) outcomes in patients with suspected HFpEF.Methods:We performed upright maximum incremental ramp cycle ergometry cardiopulmonary exercise testing with invasive hemodynamic monitoring in patients referred to a single center for evaluation of exertional dyspnea. Pulmonary capillary wedge pressure (PCWP), and direct Fick cardiac output (CO) were measured at rest and during each minute of exercise to derive ?PCWP/?CO slopes (WQ). We assessed recovery O2kinetics by measuring VO2recovery delay (VO2RD), defined as the time it took for VO2 to fall below peak VO2 (defined by the highest 30 second median within the final minute of exercise). VO2RD >25s was evaluated as a prognostic cut point based on recent data linking VO2RD >25s to increased risk of mortality in HF with reduced LVEF. HF hospitalization and HF event-free survival were assessed by Cox regression models.Results:Among 342 patients with measured VO2 kinetics and normal LVEF (age 58?14.0, 55% female, BMI 29.5?6.2, LVEF 65?6.9%, mean?SD), VO2RD >25s was present in 72 patients (27%). VO2RD increased across quartiles of WQ (Figure, ANOVA p<0.0001). After adjustment for age, sex, and BMI, VO2RD>25s was associated with a higher hazard for HF hospitalization (HR 3.35, 95% CI 1.28-8.76, p=0.014) and combined HF or death (HR 2.1, 95% CI 1.04-4.18, p=0.039).Conclusion:In patients undergoing evaluation of dyspnea on exertion, abnormal VO2recovery kinetics are associated with a steep increment in PCWP in response to exercise and lower HF-free survival. |
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