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Echocardiographic predictors of exercise intolerance in heart failure with reduced ejection fraction
Session:
Posters - D. Heart Failure
Speaker:
André Azul Freitas
Congress:
CPC 2021
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
André Azul Freitas; Valdirene Gonçalves; João Rosa; Gustavo Campos; Sofia Martinho; José Paulo Almeida; Cátia Ferreira; James Milner; João André Ferreira; Elisabete Jorge; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">INTRODUCTION:</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">Cardiopulmonary exercise testing (CPET) is routinely used in the prognostic evaluation of patients with heart failure with reduced ejection fraction (HFrEF). Left ventricular ejection fraction (LVEF) is a strong prognostic marker but have shown a bad correlation with exercise capacity. The aim of this study is to assess the relationship between echocardiographic parameters and exercise capacity in HFrEF patients.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">METHODS</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">We retrospectively assessed all patients with HFrEF submitted to CPET and echocardiography between March and September of 2019. 73 patients were eligible for analysis. ANOVA test was used to compare Weber class groups regarding echocardiographic parameters. Multivariate linear regression with a stepwise approach was used to assess independent predictors of peak VO<sub>2</sub> uptake. ROC curves were compared to assess the best parameter to discriminate a peak VO2 < 10 ml/Kg/min (Weber class D). </span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">RESULTS</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">Mean age was 53.4 </span><span style="font-size:11pt"><span style="font-family:Symbol">±</span></span><span style="font-size:11pt"> 11.7 years with 72.6% being male. Mean LVEF was 29.2</span><span style="font-size:11pt"><span style="font-family:Symbol">±</span></span><span style="font-size:11pt"> 7.7% and mean peak VO<sub>2</sub> was 13.4 </span><span style="font-size:11pt"><span style="font-family:Symbol">±</span></span><span style="font-size:11pt"> 3.8 ml/Kg/min. Between the Weber class groups, significant differences were found in left (LV) and right ventricular (RV) longitudinal strain (P<0.001 and P=0.005 respectively), in the left and right atrial reservoir strain (P=0.009 and P<0.001 respectively), in pulmonary velocity acceleration time (P=0.002) and in maximal tricuspid regurgitation velocity (TRmax) (P=0.014). Left ventricular ejection fraction, tricuspid annular plane systolic excursion, and ratio E/e` were not significantly different among exercise capacity groups. Additionally, only RV longitudinal strain (r<sup>2</sup>=0.225, P=0.008) and TRmax (r<sup>2</sup>=0.073, P=0.030) were independent predictors of peak VO<sub>2</sub>. RV longitudinal strain showed the best accuracy in discriminating a Weber class of D (AUC=0.731, IC 95% 0.613 – 0.848, P=0.005) with a calculated cut-off value of -8.6% and with a negative predictive value of 95%.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">CONCLUSION</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">RV longitudinal strain and TRmax seem to be the best echocardiographic predictors of exercise intolerance in patients with HFrEF. Since CPET is not widely available, these echocardiographic parameters can be clinically useful as a surrogate prognostic factor.</span></span></span></span></p>
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