Exercise Limitation Associated With Asymptomatic Left Ventricular Impairment: Analogy With Stage B Heart Failure | Journal Scan

Study Questions:

What is the association of exercise capacity with left ventricular hypertrophy (LVH) and systolic/diastolic dysfunction in asymptomatic patients with heart failure (HF) symptoms?


In this study, 510 asymptomatic patients were recruited with type 2 diabetes, obesity, or hypertension (ages 58 ± 12 years) and then underwent echocardiography and cardiopulmonary exercise testing. Stage B heart failure (SBHF) patients were compared to patients with subclinical dysfunction, defined as reduced LV strain (>–18%) or increased LV filling pressure (E/e’ >13).


A total of 55% of patients had hypertension, 57% had diabetes, and 69% were obese. Groups with LV abnormalities differed in terms of oxygen uptake (peak VO2), compared with normal subjects: 25.5 ± 8.2 versus 21.0 ± 8.2 for strain >–18% (p < 0.001); 26.4 ± 8.0 versus 19.0 ± 7.2 for E/e’ >13 (p < 0.0001); and 26.0 ± 7.7 versus 15.9 ± 6.9 ml/kg/min for LVH (p < 0.0001), respectively. SBHF, defined as ≥1 imaging variables present, was associated with lower peak VO2 (β = –0.20; p < 0.0001) and metabolic equivalents (β = –0.21; p < 0.0001), independent of higher body mass index and insulin resistance, older age, male sex, and treatment with beta-blockers.


The authors concluded that LVH, elevated LV filling pressure, and abnormal myocardial deformation are independently associated with impaired exercise capacity. Structural and functional markers may improve identification of SBHF in nonischemic heart disease.


As we focus more on the stages of HF and their progression, the inclusion of structural and functional markers can help recognize cardiovascular risk in these early stages of HF.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Echocardiography/Ultrasound, Hypertension

Keywords: Heart Failure, Hypertrophy, Left Ventricular, Exercise Tolerance, Diabetes Mellitus, Type 2, Echocardiography, Hypertension, Metabolic Equivalent, Obesity, Risk Factors, Systole, Diastole, Oxygen

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