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Incremental value of left ventricular diastolic function reserve index for predicting exercise capacity in patients

Eui-Young Choi1, Jong-Won Ha, Se-Joong Rim

  • 1Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|October 2, 2007
PubMed

Insights

In hypertrophic cardiomyopathy (HCM) patients, exercise capacity is linked to diastolic function changes and N-terminal-pro-B-type natriuretic peptide (BNP) levels. Assessing diastolic function reserve improves prediction beyond BNP alone.

Area of Science:

  • Cardiology
  • Cardiovascular Physiology
  • Biomarkers

Background:

  • Left ventricular diastolic function changes during exercise vary in hypertrophic cardiomyopathy (HCM).
  • Exercise capacity is a crucial indicator of prognosis in HCM patients.
  • N-terminal-pro-B-type natriuretic peptide (pro-BNP) is a known prognostic marker in cardiovascular diseases.

Purpose of the Study:

  • To investigate the association between exertional changes in mitral annular velocities and plasma pro-BNP concentration with exercise capacity in HCM patients.
  • To determine if left ventricular longitudinal diastolic function reserve can predict exercise capacity independently.
  • To evaluate the combined predictive value of diastolic function reserve and pro-BNP for exercise capacity.

Main Methods:

  • Echocardiographic Doppler parameters and plasma pro-BNP levels were measured in 32 HCM patients at rest and during graded supine bicycle exercise.
  • Mitral annular velocities (E', DeltaE') and resting pro-BNP were assessed.
  • Left ventricular longitudinal diastolic function reserve index (DeltaE' x E'(base)) was calculated.

Main Results:

  • Resting pro-BNP, E'(base), and DeltaE'(50W) were significantly correlated with exercise duration.
  • The diastolic function reserve index (DeltaE' x E'(base)) showed a significant correlation with exercise duration, independent of other factors.
  • Combining the diastolic function reserve index with resting pro-BNP improved the prediction accuracy for exercise capacity.

Conclusions:

  • Exertional changes in mitral annular velocities and plasma pro-BNP are associated with exercise capacity in HCM.
  • Left ventricular longitudinal diastolic function reserve provides incremental prognostic information beyond resting pro-BNP.
  • This assessment can enhance the prediction of exercise capacity in HCM patients.

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