Cardiopulmonary exercise variables in diastolic versus systolic heart failure

Mary Jane Farr, Chim C. Lang, John J. LaManca, Michael R. Zile, Gary Francis, Luigi Tavazzi, William H. Gaasch, Martin St. John Sutton, Haruki Itoh, Donna Mancini, MCC-135 GO1 Invest

    Research output: Contribution to journalArticle

    30 Citations (Scopus)

    Abstract

    The response to cardiopulmonary exercise (CPX) in patients with heart failure (HF) with normal left ventricular (LV) ejection fractions (EFs) is not well characterized. To determine if CPX testing could distinguish between patients with HF with normal EFs (> 50%; i.e., diastolic HF) and those with decreased EFs ( >= 50%; i.e., systolic HF), CPX responses were compared between 185 patients with systolic HF (79% men, mean age 62.6 +/- 10.9 years) and 43 with diastolic HF (54% men, mean age 67.4 +/- 9.8 years) enrolled in a phase 11 multicenter clinical trial. All patients were evaluated with echocardiography and a standardized CPX test as part of the trial. CPX variables, including oxygen uptake at peak exercise (peak VO2) and the slope of the ventilation/carbon dioxide production ratio (VE/VCO2), were determined and analyzed by core laboratory personnel. Echocardiographic measurements included the LV EF, the E/A ratio, filling time, cavity volumes, right ventricular function, and mitral regurgitation. Patients in the diastolic HF group tended to be older (p < 0.08), with more women (p < 0.006) and with greater body mass indexes (p < 0.02), than those in the systolic HF group. There was no significant difference in the use of P blockers or the incidence of coronary artery disease. Patients with diastolic HF had decreased E/A ratios (0.9 +/- 0.4 vs 1.4 +/- 1.1, p < 0.02, diastolic HF vs systolic HF) and increased filling times (30.4 +/- 3.2 vs 26.5 +/- 4.7 ms, p < 0.01, diastolic HF vs systolic HF). No significant differences in peak VO2 (14.4 +/- 1.9 vs 15.6 3.2 ml/kg/min, p = 0.06, diastolic HF vs systolic HF) were observed. The VE/VCO2 ratios for the 2 groups were abnormal and comparable (32 2 +/- 7.5 vs 34.0 +/- 8.3, p = 0.3, diastolic HF vs systolic HF). In conclusion, the CPX response in patients with diastolic HF and systolic HF is markedly abnormal and indistinguishable with regard to peak VO2 and ventilation despite marked differences in the LV EF. (C) 2008 Elsevier Inc. All rights reserved.

    Original languageEnglish
    Pages (from-to)203-206
    Number of pages4
    JournalAmerican Journal of Cardiology
    Volume102
    Issue number2
    DOIs
    Publication statusPublished - 15 Jul 2008

    Keywords

    • TRANSPLANTATION
    • DYSFUNCTION

    Cite this

    Farr, M. J., Lang, C. C., LaManca, J. J., Zile, M. R., Francis, G., Tavazzi, L., ... MCC-135 GO1 Invest (2008). Cardiopulmonary exercise variables in diastolic versus systolic heart failure. American Journal of Cardiology, 102(2), 203-206. https://doi.org/10.1016/j.amjcard.2008.03.041
    Farr, Mary Jane ; Lang, Chim C. ; LaManca, John J. ; Zile, Michael R. ; Francis, Gary ; Tavazzi, Luigi ; Gaasch, William H. ; Sutton, Martin St. John ; Itoh, Haruki ; Mancini, Donna ; MCC-135 GO1 Invest. / Cardiopulmonary exercise variables in diastolic versus systolic heart failure. In: American Journal of Cardiology. 2008 ; Vol. 102, No. 2. pp. 203-206.
    @article{22a0b108be604839a457143b01c75fe6,
    title = "Cardiopulmonary exercise variables in diastolic versus systolic heart failure",
    abstract = "The response to cardiopulmonary exercise (CPX) in patients with heart failure (HF) with normal left ventricular (LV) ejection fractions (EFs) is not well characterized. To determine if CPX testing could distinguish between patients with HF with normal EFs (> 50{\%}; i.e., diastolic HF) and those with decreased EFs ( >= 50{\%}; i.e., systolic HF), CPX responses were compared between 185 patients with systolic HF (79{\%} men, mean age 62.6 +/- 10.9 years) and 43 with diastolic HF (54{\%} men, mean age 67.4 +/- 9.8 years) enrolled in a phase 11 multicenter clinical trial. All patients were evaluated with echocardiography and a standardized CPX test as part of the trial. CPX variables, including oxygen uptake at peak exercise (peak VO2) and the slope of the ventilation/carbon dioxide production ratio (VE/VCO2), were determined and analyzed by core laboratory personnel. Echocardiographic measurements included the LV EF, the E/A ratio, filling time, cavity volumes, right ventricular function, and mitral regurgitation. Patients in the diastolic HF group tended to be older (p < 0.08), with more women (p < 0.006) and with greater body mass indexes (p < 0.02), than those in the systolic HF group. There was no significant difference in the use of P blockers or the incidence of coronary artery disease. Patients with diastolic HF had decreased E/A ratios (0.9 +/- 0.4 vs 1.4 +/- 1.1, p < 0.02, diastolic HF vs systolic HF) and increased filling times (30.4 +/- 3.2 vs 26.5 +/- 4.7 ms, p < 0.01, diastolic HF vs systolic HF). No significant differences in peak VO2 (14.4 +/- 1.9 vs 15.6 3.2 ml/kg/min, p = 0.06, diastolic HF vs systolic HF) were observed. The VE/VCO2 ratios for the 2 groups were abnormal and comparable (32 2 +/- 7.5 vs 34.0 +/- 8.3, p = 0.3, diastolic HF vs systolic HF). In conclusion, the CPX response in patients with diastolic HF and systolic HF is markedly abnormal and indistinguishable with regard to peak VO2 and ventilation despite marked differences in the LV EF. (C) 2008 Elsevier Inc. All rights reserved.",
    keywords = "TRANSPLANTATION, DYSFUNCTION",
    author = "Farr, {Mary Jane} and Lang, {Chim C.} and LaManca, {John J.} and Zile, {Michael R.} and Gary Francis and Luigi Tavazzi and Gaasch, {William H.} and Sutton, {Martin St. John} and Haruki Itoh and Donna Mancini and {MCC-135 GO1 Invest}",
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    Farr, MJ, Lang, CC, LaManca, JJ, Zile, MR, Francis, G, Tavazzi, L, Gaasch, WH, Sutton, MSJ, Itoh, H, Mancini, D & MCC-135 GO1 Invest 2008, 'Cardiopulmonary exercise variables in diastolic versus systolic heart failure', American Journal of Cardiology, vol. 102, no. 2, pp. 203-206. https://doi.org/10.1016/j.amjcard.2008.03.041

    Cardiopulmonary exercise variables in diastolic versus systolic heart failure. / Farr, Mary Jane; Lang, Chim C.; LaManca, John J.; Zile, Michael R.; Francis, Gary; Tavazzi, Luigi; Gaasch, William H.; Sutton, Martin St. John; Itoh, Haruki; Mancini, Donna; MCC-135 GO1 Invest.

    In: American Journal of Cardiology, Vol. 102, No. 2, 15.07.2008, p. 203-206.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Cardiopulmonary exercise variables in diastolic versus systolic heart failure

    AU - Farr, Mary Jane

    AU - Lang, Chim C.

    AU - LaManca, John J.

    AU - Zile, Michael R.

    AU - Francis, Gary

    AU - Tavazzi, Luigi

    AU - Gaasch, William H.

    AU - Sutton, Martin St. John

    AU - Itoh, Haruki

    AU - Mancini, Donna

    AU - MCC-135 GO1 Invest

    PY - 2008/7/15

    Y1 - 2008/7/15

    N2 - The response to cardiopulmonary exercise (CPX) in patients with heart failure (HF) with normal left ventricular (LV) ejection fractions (EFs) is not well characterized. To determine if CPX testing could distinguish between patients with HF with normal EFs (> 50%; i.e., diastolic HF) and those with decreased EFs ( >= 50%; i.e., systolic HF), CPX responses were compared between 185 patients with systolic HF (79% men, mean age 62.6 +/- 10.9 years) and 43 with diastolic HF (54% men, mean age 67.4 +/- 9.8 years) enrolled in a phase 11 multicenter clinical trial. All patients were evaluated with echocardiography and a standardized CPX test as part of the trial. CPX variables, including oxygen uptake at peak exercise (peak VO2) and the slope of the ventilation/carbon dioxide production ratio (VE/VCO2), were determined and analyzed by core laboratory personnel. Echocardiographic measurements included the LV EF, the E/A ratio, filling time, cavity volumes, right ventricular function, and mitral regurgitation. Patients in the diastolic HF group tended to be older (p < 0.08), with more women (p < 0.006) and with greater body mass indexes (p < 0.02), than those in the systolic HF group. There was no significant difference in the use of P blockers or the incidence of coronary artery disease. Patients with diastolic HF had decreased E/A ratios (0.9 +/- 0.4 vs 1.4 +/- 1.1, p < 0.02, diastolic HF vs systolic HF) and increased filling times (30.4 +/- 3.2 vs 26.5 +/- 4.7 ms, p < 0.01, diastolic HF vs systolic HF). No significant differences in peak VO2 (14.4 +/- 1.9 vs 15.6 3.2 ml/kg/min, p = 0.06, diastolic HF vs systolic HF) were observed. The VE/VCO2 ratios for the 2 groups were abnormal and comparable (32 2 +/- 7.5 vs 34.0 +/- 8.3, p = 0.3, diastolic HF vs systolic HF). In conclusion, the CPX response in patients with diastolic HF and systolic HF is markedly abnormal and indistinguishable with regard to peak VO2 and ventilation despite marked differences in the LV EF. (C) 2008 Elsevier Inc. All rights reserved.

    AB - The response to cardiopulmonary exercise (CPX) in patients with heart failure (HF) with normal left ventricular (LV) ejection fractions (EFs) is not well characterized. To determine if CPX testing could distinguish between patients with HF with normal EFs (> 50%; i.e., diastolic HF) and those with decreased EFs ( >= 50%; i.e., systolic HF), CPX responses were compared between 185 patients with systolic HF (79% men, mean age 62.6 +/- 10.9 years) and 43 with diastolic HF (54% men, mean age 67.4 +/- 9.8 years) enrolled in a phase 11 multicenter clinical trial. All patients were evaluated with echocardiography and a standardized CPX test as part of the trial. CPX variables, including oxygen uptake at peak exercise (peak VO2) and the slope of the ventilation/carbon dioxide production ratio (VE/VCO2), were determined and analyzed by core laboratory personnel. Echocardiographic measurements included the LV EF, the E/A ratio, filling time, cavity volumes, right ventricular function, and mitral regurgitation. Patients in the diastolic HF group tended to be older (p < 0.08), with more women (p < 0.006) and with greater body mass indexes (p < 0.02), than those in the systolic HF group. There was no significant difference in the use of P blockers or the incidence of coronary artery disease. Patients with diastolic HF had decreased E/A ratios (0.9 +/- 0.4 vs 1.4 +/- 1.1, p < 0.02, diastolic HF vs systolic HF) and increased filling times (30.4 +/- 3.2 vs 26.5 +/- 4.7 ms, p < 0.01, diastolic HF vs systolic HF). No significant differences in peak VO2 (14.4 +/- 1.9 vs 15.6 3.2 ml/kg/min, p = 0.06, diastolic HF vs systolic HF) were observed. The VE/VCO2 ratios for the 2 groups were abnormal and comparable (32 2 +/- 7.5 vs 34.0 +/- 8.3, p = 0.3, diastolic HF vs systolic HF). In conclusion, the CPX response in patients with diastolic HF and systolic HF is markedly abnormal and indistinguishable with regard to peak VO2 and ventilation despite marked differences in the LV EF. (C) 2008 Elsevier Inc. All rights reserved.

    KW - TRANSPLANTATION

    KW - DYSFUNCTION

    U2 - 10.1016/j.amjcard.2008.03.041

    DO - 10.1016/j.amjcard.2008.03.041

    M3 - Article

    VL - 102

    SP - 203

    EP - 206

    JO - American Journal of Cardiology

    JF - American Journal of Cardiology

    SN - 0002-9149

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    ER -