The role of exercise echocardiography in the diagnostics of heart failure with normal left ventricular ejection fraction
Methods and results Eighty-four patients with exertional dyspnoea and normal LV EF and 14 healthy controls underwent spirometry, NT-proBNP plasma analysis, and exercise echocardiography. Doppler LV inflow and tissue mitral and tricuspid annular velocities were analysed at rest and immediately after the termination of exercise. Of the 30 patients with the evidence of HFNEF, 6 (20%) patients had only isolated exercise-induced HFNEF. When compared with the remaining patients, those with HFNEF had a significantly lower resting and exercise peak mitral annular systolic velocity (Sa) and the mitral annular velocity during atrial contraction, lower exercise peak mitral annular velocity at early diastole, and lower exercise peak systolic velocity of tricuspid annular motion. The multivariate logistic regression analysis including both parameters standardly defining HFNEF and the new Doppler variables potentially associated with the diagnosis of HFNEF revealed that NT-proBNP, LV mass index, left atrial volume index, and Sa significantly and independently predict the diagnosis of HFNEF.
Conclusion A significant proportion of patients require exercise to diagnose HFNEF. Sa appears to be a significant independent predictor of HFNEF, which may increase the diagnostic value of models utilizing the variables recommended by the European Society of Cardiology guidelines.
Immediately after resting echocardiography, symptom-limited exercise was performed by bicycle ergometry (Kettler X7, Siemens, Germany) in a sitting position. The initial workload of 25 W was increased by 25 W every 2 min until the limited symptoms appeared (dyspnoea, leg, or general fatigue). Immediately after exercise, in the patient's position corresponding to the pre-exercise examination at rest, the following images were obtained: transmitral pulsed Doppler filling flow and Doppler tissue recordings of septal and lateral mitral annular motion and of tricuspid annular motion.