Steding-Ehrenborg Katarina, Nelsson Anders, Engblom Henrik, Ostenfeld Ellen, Arvidsson Per M, Magnusson Martin, Smith J Gustav, Arheden Håkan
Clinical Physiology, Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden.
Department of Clinical Physiology, Skåne University Hospital, Lund, 221 85 Lund, Sweden.
Eur Heart J Imaging Methods Pract. 2025 Sep 12;3(2):qyaf115. doi: 10.1093/ehjimp/qyaf115. eCollection 2025 Jul.
Peak oxygen uptake (VOpeak) is closely related to total heart volume (THV) in healthy individuals. This study aimed to investigate (i) the association between VOpeak and THV in subjects with sub-clinical diastolic dysfunction, athletes, healthy controls, and patients with established heart failure with and without preserved ejection fraction (HFpEF and HFrEF), and (ii) whether VOpeak/THV-index can distinguish between subjects with sub-clinical diastolic dysfunction, HFpEF, HFrEF, and healthy controls.
Seventy participants were included: 15 with sub-clinical diastolic dysfunction (defined as showing only 1-2 echocardiographic signs of diastolic dysfunction, not meeting clinical diagnostic criteria), 10 athletes, 15 healthy controls, and 30 heart failure patients (15 HFpEF and 15 HFrEF). VOpeak was assessed by cardiopulmonary exercise testing and THV by cardiovascular magnetic resonance imaging. In sub-clinical diastolic dysfunction, THV was a weak determinant of VOpeak ( = 0.41, = 0.01), and even weaker in heart failure ( = 0.16, = 0.03). However, THV strongly predicted VOpeak in athletes and controls combined ( = 0.87, < 0.0001). VOpeak/THV did not distinguish healthy controls from sub-clinical diastolic dysfunction but could reliably discriminate between healthy controls and patients with heart failure.
Subjects with sub-clinical diastolic dysfunction may have an altered relationship between VOpeak and THV, approaching that of patients with established heart failure. Thus, this proof-of-concept study indicates that sub-clinical diastolic dysfunction constitutes a group of patients that may be of interest to follow over time to prevent continued deterioration of cardiac function. Furthermore, the VOpeak/THV ratio can be used to distinguish between healthy controls and overt heart failure.
在健康个体中，最大摄氧量（VOpeak）与全心容积（THV）密切相关。本研究旨在调查：（i）亚临床舒张功能障碍患者、运动员、健康对照以及射血分数保留和未保留的已确诊心力衰竭患者（HFpEF和HFrEF）中VOpeak与THV之间的关联；（ii）VOpeak/THV指数是否能够区分亚临床舒张功能障碍患者、HFpEF患者、HFrEF患者和健康对照。
纳入70名参与者：15名亚临床舒张功能障碍患者（定义为仅表现出1 - 2项舒张功能障碍的超声心动图征象，未达到临床诊断标准）、10名运动员、15名健康对照以及30名心力衰竭患者（15名HFpEF患者和15名HFrEF患者）。通过心肺运动试验评估VOpeak，通过心血管磁共振成像评估THV。在亚临床舒张功能障碍患者中，THV是VOpeak的一个较弱决定因素（r = 0.41，P = 0.01），在心力衰竭患者中更弱（r = 0.16，P = 0.03）。然而，THV在运动员和对照的组合中强烈预测VOpeak（r = 0.87，P < 0.0001）。VOpeak/THV不能区分健康对照与亚临床舒张功能障碍，但能可靠地区分健康对照与心力衰竭患者。
亚临床舒张功能障碍患者的VOpeak与THV之间的关系可能发生改变，接近已确诊心力衰竭患者的情况。因此，这项概念验证研究表明，亚临床舒张功能障碍构成了一组患者群体，随着时间推移对其进行随访可能有助于预防心脏功能的持续恶化。此外，VOpeak/THV比值可用于区分健康对照与明显心力衰竭。
