Department of Cardiac and Vascular Disease, John Paul II Hospital, Jagiellonian University, Krakow, Poland.
Kardiol Pol. 2011;69(7):656-63.
Gradual impairment of exercise tolerance is the commonest sign of heart failure (HF). Little is known as to which cardiac contributors of poor exercise capacity carry an independent prognostic information in HF.
We investigated the prognostic role of exercise echocardiography (ex-echo) in HF patients.
We studied 85 consecutive, symptomatic HF patients (66 males, mean age 62.5 ± 11.8 [range 21-83] years, mean left ventricular ejection fraction [LVEF] 27.2 ± 9.5%). The end-point was all-cause mortality. During the follow-up period (mean 43 ± 21 months) 21 patients died. Resting echocardiography and ex-echo, with the simultaneous measurement of peak oxygen uptake (VO(2peak)), was performed in each patient using a semi-supine ergometer (20 W, 2-min increments). Apart from conventional assessment of systolic and diastolic function (EF, E/A, DT, IVRT) or right ventricular systolic pressure (RVSP), tissue Doppler imaging was used for the assessment of LV and RV peak velocity (IVV) as well as acceleration during isovolumic contraction (IVA), peak velocity during ejection phase (S'), peak early diastolic velocity (E'), peak late diastolic velocity (A'), and ratio of early diastolic mitral/tricuspid velocity to peak early diastolic velocity (E/E').
Patients who died were significantly older, had lower exercise capacity, more advanced HF, greater impairment of baseline systolic function, higher baseline pulmonary artery systolic pressure, and most importantly a lack of improvement in EF, diastolic function, and further increase of RVSP during exercise. Out of all echocardiographic parameters, only peak stress EF (x(2) 6.1; p = 0.01), baseline and peak exercise RVSP (x(2) 12.5 and c(2) 18.7; p 〈 0.001; respectively), and mitral E/E' ratio (x(2) 8.9; p 〈 0.01) were univariate predictors of prognosis and remained independently prognostic when adjusted for age and sex but were eliminated from the model by NT-proBNP.
During exercise, more severe systolic and diastolic dysfunction with the elevation of pulmonary arterial pressure is more prevalent in HF patients who have a poorer outcome. The estimation of common parameters such as EF, RVSP and E/E' using ex-echo, provides prognostic information in HF.
运动耐量逐渐下降是心力衰竭（HF）最常见的征象。对于哪些心脏因素导致运动能力下降在 HF 中具有独立的预后信息，目前知之甚少。
我们研究了运动超声心动图（ex-echo）在 HF 患者中的预后作用。
我们研究了 85 例连续的、有症状的 HF 患者（66 例男性，平均年龄 62.5±11.8[范围 21-83]岁，平均左心室射血分数[LVEF]27.2±9.5%）。终点是全因死亡率。在随访期间（平均 43±21 个月），有 21 例患者死亡。每位患者均使用半卧位测力计（20 W，2 分钟递增）进行静息超声心动图和 ex-echo 检查，同时测量峰值摄氧量（VO（2peak））。除了常规评估收缩和舒张功能（EF、E/A、DT、IVRT）或右心室收缩压（RVSP）外，组织多普勒成像还用于评估 LV 和 RV 峰值速度（IVV）以及等容收缩期加速度（IVA）、射血期峰值速度（S'）、早期舒张期峰值速度（E'）、晚期舒张期峰值速度（A'）以及二尖瓣/三尖瓣早期舒张速度与早期舒张峰值速度的比值（E/E'）。
死亡患者年龄较大，运动能力较低，HF 更为严重，基础收缩功能障碍更严重，基础肺动脉收缩压更高，最重要的是 EF、舒张功能在运动过程中无改善，RVSP 进一步升高。在所有超声心动图参数中，只有峰值应激 EF（x(2)6.1；p=0.01）、基础和峰值运动 RVSP（x(2)12.5 和 c(2)18.7；p〈0.001；分别）以及二尖瓣 E/E'比值（x(2)8.9；p〈0.01）是预后的单变量预测因子，在调整年龄和性别后仍然具有独立的预后价值，但被 NT-proBNP 排除在模型之外。
在运动过程中，肺动脉压升高时更严重的收缩和舒张功能障碍在预后较差的 HF 患者中更为常见。使用 ex-echo 评估 EF、RVSP 和 E/E'等常见参数可提供 HF 的预后信息。
