Justin Heizer1, Salvatore Carbone1,2, Hayley E Billingsley1,2, Benjamin W VAN Tassell3, Ross Arena4, Antonio Abbate1, Justin M Canada5. 1. VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA. 2. Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA. 3. Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, VA, USA. 4. Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA. 5. VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA - justin.m.canada@vcuhealth.org.
Abstract
BACKGROUND: Left ventricular (LV) concentric remodeling refers to a process by which increased LV relative wall thickness alters myocardial geometry, resulting in reduced LV end-diastolic volume (LVEDV) and stroke volume (SV). While the degree of concentric remodeling is a negative prognostic factor in heart failure with preserved ejection fraction (HFpEF), it is not known how it contributes to cardiorespiratory fitness (CRF). METHODS: We performed a retrospective analysis of patients with HFpEF who underwent treadmill single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) and cardiopulmonary exercise testing (CPX). From exercise SPECT-MPI, we recorded postexercise LVEDVi, LVESVi, SVi, LVEF, the presence and extent of perfusion defects, and perfusion reversibility. Peak oxygen consumption (VO<inf>2</inf>), the oxygen uptake efficiency slope (OUES), oxygen (O<inf>2</inf>) pulse, ventilatory efficiency (V<inf>E</inf>/VCO<inf>2</inf> slope), ventilatory anaerobic threshold, respiratory exchange ratio, exercise time, and maximum heart rate were obtained from CPX. Data are expressed as mean (±standard deviation). Univariate and multivariate linear regression was performed. RESULTS: We identified 23 subjects who had completed both an exercise SPECT-MPI and a CPX. Patients were more commonly women (83%), black (65%), middle age (50 [±7.3] years), and obese (Body Mass Index [BMI] 39.7 [±6.0] kg/m2). Greater LVEDVi and LVESVi correlated positively with peak VO<inf>2</inf> (R=+0.648, P=0.001; R=+0.601, P=0.002), O<inf>2</inf> pulse (R=+0.686, P<0.001; R=+0.625, P=0.001) and OUES (R=+0.882, P<0.001; R=+0.779, P<0.001). The LVEF correlated inversely with peak VO<inf>2</inf> and OUES (R=-0.450, P=0.031; R=-0.485, P=0.035). Perfusion defect area, grade of severity, and presence of reversibility were not associated with CRF variables. CONCLUSIONS: Postexercise reduced LV volumes correlate with measures of impaired CRF in patients with HFpEF, thus supporting a pathophysiologic role of concentric remodeling in impaired CRF in HFpEF.
BACKGROUND: Left ventricular (LV) concentric remodeling refers to a process by which increased LV relative wall thickness alters myocardial geometry, resulting in reduced LV end-diastolic volume (LVEDV) and stroke volume (SV). While the degree of concentric remodeling is a negative prognostic factor in heart failure with preserved ejection fraction (HFpEF), it is not known how it contributes to cardiorespiratory fitness (CRF). METHODS: We performed a retrospective analysis of patients with HFpEF who underwent treadmill single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) and cardiopulmonary exercise testing (CPX). From exercise SPECT-MPI, we recorded postexercise LVEDVi, LVESVi, SVi, LVEF, the presence and extent of perfusion defects, and perfusion reversibility. Peak oxygen consumption (VO<inf>2</inf>), the oxygen uptake efficiency slope (OUES), oxygen (O<inf>2</inf>) pulse, ventilatory efficiency (V<inf>E</inf>/VCO<inf>2</inf> slope), ventilatory anaerobic threshold, respiratory exchange ratio, exercise time, and maximum heart rate were obtained from CPX. Data are expressed as mean (±standard deviation). Univariate and multivariate linear regression was performed. RESULTS: We identified 23 subjects who had completed both an exercise SPECT-MPI and a CPX. Patients were more commonly women (83%), black (65%), middle age (50 [±7.3] years), and obese (Body Mass Index [BMI] 39.7 [±6.0] kg/m2). Greater LVEDVi and LVESVi correlated positively with peak VO<inf>2</inf> (R=+0.648, P=0.001; R=+0.601, P=0.002), O<inf>2</inf> pulse (R=+0.686, P<0.001; R=+0.625, P=0.001) and OUES (R=+0.882, P<0.001; R=+0.779, P<0.001). The LVEF correlated inversely with peak VO<inf>2</inf> and OUES (R=-0.450, P=0.031; R=-0.485, P=0.035). Perfusion defect area, grade of severity, and presence of reversibility were not associated with CRF variables. CONCLUSIONS: Postexercise reduced LV volumes correlate with measures of impaired CRF in patients with HFpEF, thus supporting a pathophysiologic role of concentric remodeling in impaired CRF in HFpEF.
Authors: Thomas Berger; Ralf Harun Zwick; Markus Stuehlinger; Wolfgang Dichtl; Gerhard Poelzl; Michael Edlinger; Otmar Pachinger; Florian Hintringer Journal: Clin Res Cardiol Date: 2010-09-23 Impact factor: 5.460
Authors: Bishnu P Dhakal; Rajeev Malhotra; Ryan M Murphy; Paul P Pappagianopoulos; Aaron L Baggish; Rory B Weiner; Nicholas E Houstis; Aaron S Eisman; Stacyann S Hough; Gregory D Lewis Journal: Circ Heart Fail Date: 2014-10-24 Impact factor: 8.790
Authors: Barry A Borlaug; Wissam A Jaber; Steve R Ommen; Carolyn S P Lam; Margaret M Redfield; Rick A Nishimura Journal: Heart Date: 2011-04-08 Impact factor: 5.994
Authors: Alan Hinderliter; Andrew Sherwood; Elizabeth C D Gullette; Michael Babyak; Robert Waugh; Anastasia Georgiades; James A Blumenthal Journal: Arch Intern Med Date: 2002-06-24
Authors: Eylem Levelt; Masliza Mahmod; Stefan K Piechnik; Rina Ariga; Jane M Francis; Christopher T Rodgers; William T Clarke; Nikant Sabharwal; Jurgen E Schneider; Theodoros D Karamitsos; Kieran Clarke; Oliver J Rider; Stefan Neubauer Journal: Diabetes Date: 2015-10-05 Impact factor: 9.461