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Minerva Cardioangiologica 2020 Sep 30

DOI: 10.23736/S0026-4725.20.05295-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Left ventricular concentric remodeling and impaired cardiorespiratory fitness in patients with heart failure and preserved ejection fraction

Justin HEIZER 1, Salvatore CARBONE 1, 2, Hayley E. BILLINGSLEY 1, 2, Benjamin W. van TASSELL 3, Ross ARENA 4, Antonio ABBATE 1, Justin M. CANADA 1

1 VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA; 2 Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, USA; 3 Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, VA, USA; 4 Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA


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BACKGROUND: Left ventricular (LV) concentric remodeling refers to a process by which increased LV relative wall thickness alters myocardial geometry, resulting in reduced LV end-diastolic volume (LVEDV) and stroke volume (SV). While the degree of concentric remodeling is a negative prognostic factor in heart failure with preserved ejection fraction (HFpEF), it is not known how it contributes to cardiorespiratory fitness (CRF).
METHODS: We performed a retrospective analysis of patients with HFpEF who underwent treadmill single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) and cardiopulmonary exercise testing (CPX). From exercise SPECT-MPI, we recorded post-exercise LVEDVi, LVESVi, SVi, LVEF, the presence and extent of perfusion defects, and perfusion reversibility. Peak oxygen consumption (VO2), the oxygen uptake efficiency slope (OUES), oxygen (O2) pulse, ventilatory efficiency (VE/VCO2 slope), ventilatory anaerobic threshold, respiratory exchange ratio, exercise time, and maximum heart rate were obtained from CPX. Data are expressed as mean (±standard deviation). Univariate and multivariate linear regression was performed.
RESULTS: We identified 23 subjects who had completed both an exercise SPECT-MPI and a CPX. Patients were more commonly women (83%), black (65%), middle-age (50 [±7.3] years), and obese (body mass index [BMI] 39.7 [±6.0] kg/m2). Greater LVEDVi and LVESVi correlated positively with peak VO2 (R=+0.648, p=0.001; R=+0.601, p=0.002),
O2 pulse (R=+0.686, p<0.001; R=+0.625, p=0.001) and OUES (R=+0.882, p<0.001; R=+0.779, p<0.001). The LVEF correlated inversely with peak VO2 and OUES (R=-0.450, p=0.031; R=-0.485, p=0.035). Perfusion defect area, grade of severity, and presence of reversibility were not associated with CRF variables.
CONCLUSIONS: Post-exercise reduced LV volumes correlate with measures of impaired CRF in patients with HFpEF, thus supporting a pathophysiologic role of concentric remodeling in impaired CRF in HFpEF.


KEY WORDS: Heart failure; Cardiorespiratory fitness; Myocardial perfusion imaging; Oxygen consumption

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