RV Myocardial Strain During Pre-Load Augmentation Is Associated With Exercise Capacity in Patients With Chronic HF

OBJECTIVES The aim of this study was to assess the relationship between right ventricular (RV) function during pre-load augmentation and exercise tolerance. BACKGROUND Peak oxygen uptake (VO2) is a strong predictor of mortality in chronic heart failure. Cardiac function during pre-load augmentation is an important part of the phenomenon in the evaluation of exercise capacity. METHODS We prospectively performed echocardiographic studies in 68 chronic heart failure patients with cardiopulmonary exercise testing (mean age 60 +/- 12 years; 69% male). After resting evaluations, echocardiographic parameters were repeated during leg positive pressure (LPP). Exercise capacity was assessed by peak VO2 in all patients (left ventricular ejection fraction: 43 +/- 15%). RESULTS Patients with severely reduced exercise capacity (peak VO2 < 14 ml/kg/min) had significantly lower stroke volume index, left ventricular global longitudinal strain and RV strain and higher filling pressure (E/e' and pulmonary arterial systolic pressure) than the remainder. Stroke volume index (beta = 0.49), global longitudinal strain (beta = -0.61), E/e' (beta = -0.32), pulmonary arterial systolic pressure (beta = -0.57), and RV strain (beta = -0.66) during LPP were independently correlated to peak VO2 (all p < 0.01). RV strain during LPP was the most powerful predictor in identifying patients with severely reduced exercise capacity (cut off value: -17%; sensitivity: 81%; specificity: 88%; areas under the curve: 0.88; p < 0.001) compared with other variables including resting parameters. CONCLUSIONS RV strain during pre-load augmentation correlated independently to peak V(O)2 and was a powerful predictor in identifying patients with severely reduced exercise capacity. (C) 2017 by the American College of Cardiology Foundation.