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DIASTOLIC RESPONSE TO EXERCISE IS ASSOCIATED WITH EXERCISE-INDUCED CHANGES IN ARTERIAL COMPLIANCE
Abstracts 13th Asia Pacific Congress of Doppler Echocardiography, Brisbane, 17–19 May, 2009
PEAK VO2 AS A MARKER OF LEFT VENTRICULAR SYSTOLIC AND DIASTOLIC FUNCTION IN A HEALTHY ADULT POPULATION E.M. Chia, C. Hsieh 2 , D. Leung 1 , L. Thomas 1 1 Liverpool
Hospital, University of New South Wales, Sydney, Australia 2 University of Sydney, Sydney, Australia Background: Expired gas analysis to assess maximal oxygen uptake (VO2 max) can be useful in differentiating cardiac from respiratory disease. Our aim was to assess if VO2 max correlates with left ventricular (LV) systolic and diastolic function. Method: 51 healthy adults had a resting TTE and LV ejection fraction (EF), mitral inflow peak E and tissue Doppler parameters at the septal annulus were measured. They then exercised on a Bruce protocol stress test with continuous breath-by-breath expired gas analysis. Results: With increasing age a decrease in peak VO2 /kg was noted. As expected, increasing peak VO2 /kg correlated with % of maximal heart rate achieved, METS and exercise duration (see table). There was no significant correlation of LVEF or peak E with peak VO2 /kg. However, a significant correlation of tissue Doppler parameters for both systolic (Septal S ) and diastolic Septal (E ) was observed. Conclusion: In a healthy adult population, Peak VO2 achieved is a good marker of cardiovascular fitness and correlates with tissue Doppler indices of systolic and diastolic function.
Age (years) Exercise time (min) % of max heart rate METS LVEF (%) Septal S (cm/s) Peak E vel (cm/s) Septal E vel (cm/s)
Mean ± S.D.
R value
P value
36 ± 11 10:46 ± 2:58 99.0 ± 7.5 12.7 ± 3.0 62 ± 5.2 8.2 ± 1.5 76.5 ± 14.1 10.3 ± 2.5
0.39 0.7 0.6 0.8 0.04 0.3 0.1 0.4
<0.05 <0.05 <0.05 <0.05 NS <0.05 NS <0.05
doi:10.1016/j.hlc.2009.03.005 DIASTOLIC RESPONSE TO EXERCISE IS ASSOCIATED WITH EXERCISE-INDUCED CHANGES IN ARTERIAL COMPLIANCE Johnston 2 , R.L. D.J. Holland, E.M. 1 Marwick , J.E. Sharman 1,2
Leano 1 , T.H.
1 The
University of Queensland, Department of Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia 2 School of Human Movement Studies, Princess Alexandra Hospital, Brisbane, QLD, Australia Exercise intolerance due to dyspnoea is common in patients with diastolic dysfunction, implicating the role of raised left ventricular (LV) filling pressure. Exercise E/E is
3
valid as a measure of LV diastolic pressure with exercise. The aim of this study was to identify whether changes of arterial compliance are responsible for increases in E/E with exercise. Ten patients with exercise intolerance and raised LV filling pressure during exercise (IFPE; E/E > 15; 63 ± 9 years, 10 female) and 10 age and sex-matched controls with normal filling pressure (E/E < 13; 61 ± 7 years) were studied. Aortic pulse wave velocity (PWV) was measured at rest whereas simultaneous measurement of E/E and estimated LV afterload (augmentation index; AIx, and systolic blood pressure; SBP) were recorded by radial tonometry at rest and post maximal treadmill exercise. Resting PWV was higher in patients with IFPE (10.5 ± 3.1 m/s vs. 8.1 ± 1.7 m/s, P < 0.05) but there was no difference in brachial or central SBP between groups (P > 0.1). In control patients, E/E did not significantly change from rest to maximal exercise (11.5–10.7; P = 0.47), whereas there was an increase of borderline significance (16.3–18.9; P = 0.06) in patients with IFPE. There was a strong correlation between the change in AIx and the change in E/E with exercise in patients with IFPE (r = 0.83, P < 0.001), but not in controls (r = 0.41, P = 0.24). In conclusion, exercise-induced changes in arterial haemodynamics are significantly associated with the LV filling pressure response to exercise. Arterial function may be an important target for treating symptoms associated with raised LV filling pressure with exertion. doi:10.1016/j.hlc.2009.03.006 MAXIMUM LEFT ATRIAL VOLUME INDEX IS THE STRONGEST ECHOCARDIOGRAPHIC PROGNOSTIC FACTOR FOR ADVERSE CARDIAC EVENTS OVER A LONG FOLLOW UP PERIOD IN AN UNSELECTED POPULATION D.Y. Leung, C. Chi, K. Kappadu, L. Thomas Liverpool Hospital, Sydney, NSW, Australia Background: Various echo parameters including LV function, LV mass, mitral inflow pattern and Left atrial (LA) volume have been shown to be of prognostic value in selected cardiac patients. Their relative prognostic values in an unselected population are unclear. Methods: 483 consecutive patients (aged 47 ± 17 years, 259 men), had transthoracic echo and were prospectively followed up for up to 7.8 (median 5.8) years. Results: Maximum LA volume index (LAVI) was 25.2 ± 8.5 mL with LVEF of 50 ± 10%. Follow up was 97% complete. 144 patients (31%) developed at least one endpoint event. 71 patients (15%) died, 20 (4.3%) developed atrial fibrillation (AF), 33 (7%) strokes, 16 heart failure (CCF, 3.4%), 29 myocardial infarct (MI, 6.2%) with 86 patients (18.3%) reaching a combined endpoint of AF, CCF, MI, stroke or death. Kaplan–Meier curves showed increasing LAVI quartiles was associated with decreased event-free survival (p = 0.03). LVEF < 50%, mitral deceleration time <150 ms, restrictive LV filling, elevated LV mass were not independent predictors.
ABSTRACTS
Heart, Lung and Circulation
PEAK VO2 AS A MARKER OF LEFT VENTRICULAR SYSTOLIC AND DIASTOLIC FUNCTION IN A HEALTHY ADULT POPULATION E.M. Chia, C. Hsieh 2 , D. Leung 1 , L. Thomas 1 1 Liverpool
Hospital, University of New South Wales, Sydney, Australia 2 University of Sydney, Sydney, Australia Background: Expired gas analysis to assess maximal oxygen uptake (VO2 max) can be useful in differentiating cardiac from respiratory disease. Our aim was to assess if VO2 max correlates with left ventricular (LV) systolic and diastolic function. Method: 51 healthy adults had a resting TTE and LV ejection fraction (EF), mitral inflow peak E and tissue Doppler parameters at the septal annulus were measured. They then exercised on a Bruce protocol stress test with continuous breath-by-breath expired gas analysis. Results: With increasing age a decrease in peak VO2 /kg was noted. As expected, increasing peak VO2 /kg correlated with % of maximal heart rate achieved, METS and exercise duration (see table). There was no significant correlation of LVEF or peak E with peak VO2 /kg. However, a significant correlation of tissue Doppler parameters for both systolic (Septal S ) and diastolic Septal (E ) was observed. Conclusion: In a healthy adult population, Peak VO2 achieved is a good marker of cardiovascular fitness and correlates with tissue Doppler indices of systolic and diastolic function.
Age (years) Exercise time (min) % of max heart rate METS LVEF (%) Septal S (cm/s) Peak E vel (cm/s) Septal E vel (cm/s)
Mean ± S.D.
R value
P value
36 ± 11 10:46 ± 2:58 99.0 ± 7.5 12.7 ± 3.0 62 ± 5.2 8.2 ± 1.5 76.5 ± 14.1 10.3 ± 2.5
0.39 0.7 0.6 0.8 0.04 0.3 0.1 0.4
<0.05 <0.05 <0.05 <0.05 NS <0.05 NS <0.05
doi:10.1016/j.hlc.2009.03.005 DIASTOLIC RESPONSE TO EXERCISE IS ASSOCIATED WITH EXERCISE-INDUCED CHANGES IN ARTERIAL COMPLIANCE Johnston 2 , R.L. D.J. Holland, E.M. 1 Marwick , J.E. Sharman 1,2
Leano 1 , T.H.
1 The
University of Queensland, Department of Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia 2 School of Human Movement Studies, Princess Alexandra Hospital, Brisbane, QLD, Australia Exercise intolerance due to dyspnoea is common in patients with diastolic dysfunction, implicating the role of raised left ventricular (LV) filling pressure. Exercise E/E is
3
valid as a measure of LV diastolic pressure with exercise. The aim of this study was to identify whether changes of arterial compliance are responsible for increases in E/E with exercise. Ten patients with exercise intolerance and raised LV filling pressure during exercise (IFPE; E/E > 15; 63 ± 9 years, 10 female) and 10 age and sex-matched controls with normal filling pressure (E/E < 13; 61 ± 7 years) were studied. Aortic pulse wave velocity (PWV) was measured at rest whereas simultaneous measurement of E/E and estimated LV afterload (augmentation index; AIx, and systolic blood pressure; SBP) were recorded by radial tonometry at rest and post maximal treadmill exercise. Resting PWV was higher in patients with IFPE (10.5 ± 3.1 m/s vs. 8.1 ± 1.7 m/s, P < 0.05) but there was no difference in brachial or central SBP between groups (P > 0.1). In control patients, E/E did not significantly change from rest to maximal exercise (11.5–10.7; P = 0.47), whereas there was an increase of borderline significance (16.3–18.9; P = 0.06) in patients with IFPE. There was a strong correlation between the change in AIx and the change in E/E with exercise in patients with IFPE (r = 0.83, P < 0.001), but not in controls (r = 0.41, P = 0.24). In conclusion, exercise-induced changes in arterial haemodynamics are significantly associated with the LV filling pressure response to exercise. Arterial function may be an important target for treating symptoms associated with raised LV filling pressure with exertion. doi:10.1016/j.hlc.2009.03.006 MAXIMUM LEFT ATRIAL VOLUME INDEX IS THE STRONGEST ECHOCARDIOGRAPHIC PROGNOSTIC FACTOR FOR ADVERSE CARDIAC EVENTS OVER A LONG FOLLOW UP PERIOD IN AN UNSELECTED POPULATION D.Y. Leung, C. Chi, K. Kappadu, L. Thomas Liverpool Hospital, Sydney, NSW, Australia Background: Various echo parameters including LV function, LV mass, mitral inflow pattern and Left atrial (LA) volume have been shown to be of prognostic value in selected cardiac patients. Their relative prognostic values in an unselected population are unclear. Methods: 483 consecutive patients (aged 47 ± 17 years, 259 men), had transthoracic echo and were prospectively followed up for up to 7.8 (median 5.8) years. Results: Maximum LA volume index (LAVI) was 25.2 ± 8.5 mL with LVEF of 50 ± 10%. Follow up was 97% complete. 144 patients (31%) developed at least one endpoint event. 71 patients (15%) died, 20 (4.3%) developed atrial fibrillation (AF), 33 (7%) strokes, 16 heart failure (CCF, 3.4%), 29 myocardial infarct (MI, 6.2%) with 86 patients (18.3%) reaching a combined endpoint of AF, CCF, MI, stroke or death. Kaplan–Meier curves showed increasing LAVI quartiles was associated with decreased event-free survival (p = 0.03). LVEF < 50%, mitral deceleration time <150 ms, restrictive LV filling, elevated LV mass were not independent predictors.
ABSTRACTS
Heart, Lung and Circulation