BACKGROUND: The association between diastolic abnormality and postexercise contractile decompensation is uncertain in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF). HYPOTHESIS: The higher mitral E/annular early diastolic velocity (E/e') is relevant to postexercise regional myocardial contractile maladaptation. METHODS: Seventy HF patients with LVEF <50 % (56 males, 58 ± 15 years) were studied pre- and postexercise using tissue Doppler echocardiography. We evaluated the mean and standard deviation of systolic myocardial velocity (Sm) and electromechanical delay (Ts) of 12 left ventricular segments, and further analyzed the corresponding changes of septal and posterolateral segments. RESULTS: The higher mitral E/e' was associated with more blunted heterogeneity of Sm and greater ventricular dyssynchrony after exercise. This is due to the posterolateral wall not being able to increase Sm with exercise to the same degree as the septum (decreased posterolateral/septal Sm ratio). Furthermore, the postexercise aggravated difference of Ts between septum and posterolateral segments leads to more dyssynchronous contraction in the higher E/e' groups. An E/e' ≥10 predicted a postexercise posterolateral/septal Sm ≤ 1 (odds ratio [OR]: 5.8, 95% confidence interval [CI]: 1.5-22.6, P = 0.011), and a difference of Ts between septum and posterolateral segments >65 ms (OR: 64, 95% CI: = 6-651, P < 0.001) in HF patients with reduced LVEF in multivariate analysis. CONCLUSIONS: The higher mitral E/e'-related postexercise maladaptation of myocardial contractile motion and synchronicity suggests the involvement of systolic abnormality in exercise pathophysiology in HF patients with reduced LVEF.
BACKGROUND: The association between diastolic abnormality and postexercise contractile decompensation is uncertain in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF). HYPOTHESIS: The higher mitral E/annular early diastolic velocity (E/e') is relevant to postexercise regional myocardial contractile maladaptation. METHODS: Seventy HF patients with LVEF <50 % (56 males, 58 ± 15 years) were studied pre- and postexercise using tissue Doppler echocardiography. We evaluated the mean and standard deviation of systolic myocardial velocity (Sm) and electromechanical delay (Ts) of 12 left ventricular segments, and further analyzed the corresponding changes of septal and posterolateral segments. RESULTS: The higher mitral E/e' was associated with more blunted heterogeneity of Sm and greater ventricular dyssynchrony after exercise. This is due to the posterolateral wall not being able to increase Sm with exercise to the same degree as the septum (decreased posterolateral/septal Sm ratio). Furthermore, the postexercise aggravated difference of Ts between septum and posterolateral segments leads to more dyssynchronous contraction in the higher E/e' groups. An E/e' ≥10 predicted a postexercise posterolateral/septal Sm ≤ 1 (odds ratio [OR]: 5.8, 95% confidence interval [CI]: 1.5-22.6, P = 0.011), and a difference of Ts between septum and posterolateral segments >65 ms (OR: 64, 95% CI: = 6-651, P < 0.001) in HF patients with reduced LVEF in multivariate analysis. CONCLUSIONS: The higher mitral E/e'-related postexercise maladaptation of myocardial contractile motion and synchronicity suggests the involvement of systolic abnormality in exercise pathophysiology in HF patients with reduced LVEF.
Authors: Matthijs F M van Oosterhout; Theo Arts; James B Bassingthwaighte; Robert S Reneman; Frits W Prinzen Journal: Cardiovasc Res Date: 2002-03 Impact factor: 10.787
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Authors: S R Ommen; R A Nishimura; C P Appleton; F A Miller; J K Oh; M M Redfield; A J Tajik Journal: Circulation Date: 2000-10-10 Impact factor: 29.690
Authors: Dalane W Kitzman; William C Little; Peter H Brubaker; Roger T Anderson; W Gregory Hundley; Christian T Marburger; Bridget Brosnihan; Timothy M Morgan; Kathryn P Stewart Journal: JAMA Date: 2002-11-06 Impact factor: 56.272
Authors: Mei Wang; Gabriel W K Yip; Angela Y M Wang; Yan Zhang; Pik Yuk Ho; Mui Kiu Tse; Peggo K W Lam; John E Sanderson Journal: J Am Coll Cardiol Date: 2003-03-05 Impact factor: 24.094
Authors: S Dagdelen; N Eren; H Karabulut; I Akdemir; M Ergelen; M Saglam; M Yüce; C Alhan; N Caglar Journal: J Am Soc Echocardiogr Date: 2001-10 Impact factor: 5.251
Authors: Margaret M Redfield; Steven J Jacobsen; John C Burnett; Douglas W Mahoney; Kent R Bailey; Richard J Rodeheffer Journal: JAMA Date: 2003-01-08 Impact factor: 56.272