Heart failure with a preserved ejection fraction additive value of an exercise stress echocardiography

Heart failure (HF) with a preserved (P) left ventricular (LV) ejection fraction (EF) is common, though its diagnosis and physiopathology remains unclear. We sought to analyse the myocardial characteristics at rest and during a sub-maximal exercise test in patients with HFPEF.

Standardized sub-maximal exercise stress echocardiography was performed in (i) 21 patients from the Karolinska Rennes Prospective Study of Heart Failure with Preserved Left Ventricular Ejection Fraction HFPEF registry, whose LVEF was ≥45% and (ii) 15 control patients free of any manifestations of HF. During a sub-maximal exercise test, LV systolic function measured as a global four-chamber longitudinal strain was -17±5% in patients with HFPEF vs. -22±4% in controls (P<0.001), LV longitudinal diastolic relaxation, expressed as e' (septal and lateral walls averaged) was 9±2 cm/s in patients vs. 15±4 cm/s in controls (P<0.001), and RV longitudinal systolic function, expressed as RV s', was 14±3 cm/s in patients vs. 18±1 cm/s in controls (P=0.03). LV afterload (arterial elastance) was 2.7±1 mmHg/mL and was correlated with a decrease in LV longitudinal strain (R=0.51, P<0.01) during exercise.

The assessment of longitudinal systolic and diastolic LV and RV functions is valuable during a sub-maximal exercise stress echocardiography to confirm the heart dysfunction related to the HFPEF symptoms. It might be used as a diagnostic test for difficult clinical situations. ClinicalTrials.gov identifier: NCT01091467.