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Low level exercise echocardiography helps diagnose early stage heart failure with preserved ejection fraction: a study of echocardiography versus catheterization

Clinical Research in Cardiology volume 106, pages 192–201 (2017)Cite this article

Abstract

Background

Increased left ventricular end-diastolic pressure (LVEDP) with exercise is an early sign of heart failure with preserved left ventricular ejection fraction (LVEF). The abnormal exercise increase in LVEDP is nonlinear, with most change occurring at low-level exercise. Data on non-invasive approach of this condition are scarce. Our objective was assessing E/e′ to estimate low level exercise LVEDP using a direct invasive measurement as the reference method.

Methods and results

Sixty patients with LVEF >50 % prospectively underwent both exercise cardiac catheterization and echocardiography. E/e′ was measured at rest and during low-level exercise. Abnormal LVEDP was defined as >16 mmHg. Patients with a history of coronary artery disease and/or abnormal LV morphology were classified as having apparent cardiac disease (CD). Thirty-four (57 %) patients had elevated LVEDP only during exercise. Most of the change in LVEDP occurred since the first exercise level (25 W). There was a correlation between LVEDP and septal E/e′ at rest and during exercise. Lateral E/e′ and E/average e′ ratio had worse correlations with LVEDP. In the whole population, exercise septal E/e′ at 25 W had the best accuracy for abnormal exercise LVEDP, area under curve (AUC) = 0.79. However, while low-level exercise septal E/e′ had a high accuracy in CD patients (n = 26, AUC = 0.96), E/e′ was not linked to LVEDP in patients without CD (n = 34).

Conclusion

Low-level exercise septal E/e′ is valuable for predicting abnormal exercise LVEDP in patients with preserved LVEF and apparent CD. However, this new diagnosis approach appears not reliable in patients with normal LV morphology and without coronary artery disease.

Clinical Trial Registration

https://clinicaltrials.gov. Unique identifier: NCT01714752.

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Acknowledgments

We thank Anissa Bouzamondo, Anne-Claire Coyne and Justine Pollet (French Society of Cardiology) for logistical and data-managing support as well as Sylvie Lang for careful review of the manuscript.

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Affiliations

  1. Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France

    Nadjib Hammoudi, Florent Laveau, Gérard Helft, Olivier Barthelemy, Alexandre Ceccaldi, Thibaut Petroni, Emmanuel Berman, Michel Komajda, Pierre-Louis Michel, Claude Le Feuvre & Richard Isnard

  2. Département de Biostatistiques, Centre Hospitalier Universitaire Pitié-Salpêtrière, Université Paris 6, Paris, France

    Nathalie Cozic & Alain Mallet

Authors
  1. Nadjib Hammoudi
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  2. Florent Laveau
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Correspondence to Nadjib Hammoudi.

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Funding

This work was supported by the French Federation of Cardiology and the French Society of Cardiology.

Conflict of interest

Dr. Laveau was supported by a grant from the French Federation of Cardiology. Dr. Komajda has performed consulting/advisory activities for Servier, Bristol-Myers Squibb, AstraZeneca, Menarini, Novartis, MSD, and Sanofi-Aventis. The other authors have no conflict of interest to declare related to the present study.

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392_2016_1039_MOESM4_ESM.tif

Linear correlation between LVEDP and E/e’ ratio at rest and during exercise in the whole study population. E/e’, the ratio of early diastolic transmitral velocity to tissue velocity; LVEDP, left ventricular end-diastolic pressure (TIFF 654 kb)

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Hammoudi, N., Laveau, F., Helft, G. et al. Low level exercise echocardiography helps diagnose early stage heart failure with preserved ejection fraction: a study of echocardiography versus catheterization. Clin Res Cardiol 106, 192–201 (2017). https://doi.org/10.1007/s00392-016-1039-0

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  • DOI: https://doi.org/10.1007/s00392-016-1039-0

Keywords

  • Exercise
  • Hemodynamics
  • Echocardiography
  • Heart failure