de la Espriella Rafael, Palau Patricia, Losito Maurizio, Crisci Giulia, Miñana Gema, Domínguez Eloy, Bertomeu-González Vicente, Bodí Vicent, Sanchis Juan, Bayés-Genís Antoni, Wahlberg Kramer J, Meyer Markus, Guazzi Marco, Núñez Julio
Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain.
Eur J Heart Fail. 2024 Dec;26(12):2544-2552. doi: 10.1002/ejhf.3401. Epub 2024 Jul 30.
Emerging evidence suggests that smaller left ventricular volumes may identify subjects with lower cardiorespiratory fitness. Whether left ventricular size predicts functional capacity in patients with heart failure with preserved ejection fraction (HFpEF) is unclear. This study aimed to explore the association between indexed left ventricular end-diastolic volume (iLVEDV) and maximal functional capacity, assessed by peak oxygen consumption (peakVO), in stable outpatients with HFpEF.
We prospectively analysed data from 133 consecutive stable outpatients who underwent cardiopulmonary exercise testing and echocardiography on the same day. Data were validated in a cohort of HFpEF patients from San Paolo Hospital, Milan, Italy. A multivariable linear regression assessed the association between iLVEDV and peakVO. The mean age was 73.2 ± 10.5 years, and 75 (56.4%) were women. The median iLVEDV, indexed left ventricular end-systolic volume, and left ventricular ejection fraction were 46 ml/m (30-56), 15 ml/m (11-19), and 66% (60-74%), respectively. The median peakVO and percentage of predicted peakVO were 11 ml/kg/min (9-13) and 64.1% (53-74.4), respectively. Adjusted linear regression analysis showed that smaller iLVEDV was associated with lower peakVO (p = 0.0001). In the validation cohort, adjusted linear regression analysis showed a consistent pattern: a smaller iLVEDV was associated with a higher likelihood of reduced peakVO (p = 0.004).
In stable outpatients with HFpEF, a smaller iLVEDV was associated with a lower maximal functional capacity. These findings suggest a need for further studies to understand the pathophysiological mechanisms underlying these observations and to explore targeted treatment strategies for this patient subgroup.
新出现的证据表明，较小的左心室容积可能提示心肺适能较低的受试者。左心室大小是否能预测射血分数保留的心力衰竭（HFpEF）患者的功能能力尚不清楚。本研究旨在探讨在稳定的HFpEF门诊患者中，左心室舒张末期容积指数（iLVEDV）与通过峰值耗氧量（peakVO₂）评估的最大功能能力之间的关联。
我们前瞻性分析了133例连续的稳定门诊患者的数据，这些患者在同一天接受了心肺运动试验和超声心动图检查。数据在意大利米兰圣保罗医院的一组HFpEF患者中进行了验证。多变量线性回归评估了iLVEDV与peakVO₂之间的关联。平均年龄为73.2±10.5岁，75例（56.4%）为女性。iLVEDV中位数、左心室收缩末期容积指数和左心室射血分数分别为46ml/m²（30 - 56）、15ml/m²（11 - 19）和66%（60 - 74%）。peakVO₂中位数和预测peakVO₂百分比分别为11ml/kg/min（9 - 13）和64.1%（53 - 74.4）。校正线性回归分析显示，较小的iLVEDV与较低的peakVO₂相关（p = 0.0001）。在验证队列中，校正线性回归分析显示出一致的模式：较小的iLVEDV与peakVO₂降低的可能性较高相关（p = 0.004）。
在稳定的HFpEF门诊患者中，较小的iLVEDV与较低的最大功能能力相关。这些发现表明需要进一步研究以了解这些观察结果背后的病理生理机制，并探索针对该患者亚组的靶向治疗策略。
