Left ventricular diastolic dysfunction and E/E' ratio as the strongest echocardiographic predictors of reduced exercise capacity after acute myocardial infarction
Ricardo Fontes-Carvalho1, Francisco Sampaio, Madalena Teixeira
1Cardiology Department, Gaia Hospital Center, Gaia, Portugal; Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
Insights
Diastolic function, not systolic, significantly impacts exercise capacity after acute myocardial infarction (AMI). The septal E/E' ratio is the key echocardiographic predictor of reduced functional capacity post-AMI.
Area of Science:
- Cardiology
- Echocardiography
- Exercise Physiology
Background:
- Reduced exercise capacity is common after acute myocardial infarction (AMI), but the underlying mechanisms involving left ventricular diastolic and systolic function are not fully understood.
- Understanding these mechanisms is crucial for improving patient outcomes and rehabilitation strategies following AMI.
Purpose of the Study:
- To investigate the predictive value of various echocardiographic parameters of diastolic and systolic function for exercise capacity in patients recovering from AMI.
- To determine which specific echocardiographic measures best identify patients with reduced functional capacity after AMI.
Main Methods:
- A cohort of 225 patients (84% male, mean age 55.1 years) one month post-AMI underwent echocardiography and cardiopulmonary exercise testing on the same day.
- Echocardiographic assessment included tissue Doppler evaluation of systolic and diastolic function, adhering to current consensus guidelines.
- Peak oxygen consumption (VO2) was measured via cardiopulmonary exercise testing to quantify exercise capacity.
Main Results:
- Peak VO2 demonstrated significant correlations with diastolic function parameters, including septal early diastolic tissue Doppler velocity (E') (r=0.42) and the septal E/E' ratio (r=-0.35).
- The septal E/E' ratio was identified as a strong predictor of impaired exercise capacity (VO2 <19 mL/kg/min), with an area under the ROC curve of 0.77.
- Multivariate analysis confirmed that the septal E/E' ratio independently predicted a decrease in peak VO2, while correlations with systolic function parameters were weaker.
Conclusions:
- Resting diastolic function parameters are the primary determinants of exercise tolerance in patients after AMI.
- The septal E/E' ratio emerges as the most significant echocardiographic predictor of diminished functional capacity following acute myocardial infarction.
Background:
The mechanisms that determine reduced exercise capacity after acute myocardial infarction (AMI) are not fully understood, especially the relative role of left ventricular diastolic and systolic function.
Hypothesis:
To evaluate the role of different diastolic and systolic function echocardiographic parameters as predictors of reduced functional capacity in patients after AMI.
Methods:
One month after AMI, 225 patients (84% male; mean age, 55.1 ± 10.9 years) were enrolled and underwent detailed echocardiography and cardiopulmonary exercise test on the same day. Systolic and diastolic function was evaluated by echocardiography according to the latest consensus recommendations, including tissue Doppler evaluation. Exercise capacity was evaluated with peak oxygen consumption (VO(2)).
Results:
Peak VO(2) was significantly correlated with early diastolic tissue Doppler velocity (E') septal (r = 0.42, P < 0.001), E' lateral (r = 0.35, P < 0.001), septal E/E' ratio (r = -0.35, P = 0.001), and lateral E/E' (r = -0.27, P < 0.001). These diastolic function parameters predicted impaired exercise capacity (VO(2) <19 mL/kg/min), with an area under the receiver operating characteristic curve of 0.77 (95% confidence interval [CI]: 0.68-0.86, P < 0.001) for septal E/E'. On multivariate analysis, for each unit increase in septal E/E' ratio there was a -0.35 (95% CI: -0.54 to -0.15) mL/kg/min decrease in peak VO(2) independently of age, sex, body mass index, hypertension, and diabetes. There was a mild correlation between peak VO(2) and systolic function parameters (r = 0.17, P = 0.01 with ejection fraction; and r = 0.23, P = 0.02 with lateral systolic tissue Doppler velocity) that persisted after multivariate adjustment.
Conclusions:
After AMI, resting diastolic function parameters were the strongest correlates of exercise tolerance. Septal E/E' ratio was the best echocardiographic predictor of reduced functional capacity.
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