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Left Ventricular Dysfunction and Exercise Capacity Trajectory: Implications for Subclinical Heart Failure Staging
Julian W Sacre1, Chiew Wong2, Yih-Kai Chan3
1Baker Heart & Diabetes Institute, Melbourne, Australia.
JACC. Cardiovascular Imaging
|February 19, 2018
Summary
Stage B heart failure (SBHF) patients with persistent elevated E/e' or left ventricular systolic dysfunction (LVSD) experienced reduced exercise capacity. Reversion of these abnormalities preserved exercise capacity, suggesting targets for heart failure prevention.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Heart Failure Research
Background:
- Left ventricular (LV) abnormalities in Stage B heart failure (SBHF) may precede clinical symptoms and impact exercise capacity.
- Understanding these early changes is crucial for improving risk stratification in heart failure (HF).
Purpose of the Study:
- To investigate the association between SBHF, its specific LV abnormalities, and changes in exercise capacity over time.
- To determine if the normalization of LV abnormalities influences the trajectory of exercise capacity.
Main Methods:
- Echocardiography and 6-minute walk distance (6MWD) were assessed at baseline and 3-year follow-up in 268 patients (Stage A and SBHF).
- Changes in 6MWD were compared between groups and analyzed based on the presence and persistence of LV abnormalities: LV hypertrophy, regional wall motion abnormality (RWMA), LV systolic dysfunction (LVSD), and elevated E/e' ratio.
Main Results:
- No significant difference in 6MWD change was observed between Stage A and SBHF patients overall.
- Within SBHF, persistent elevated E/e' and LVSD were associated with significant declines in 6MWD (-34m and -41m, respectively).
- LV hypertrophy and RWMA did not show significant associations with 6MWD decline, nor did patients with reverted LVSD or elevated E/e'.
Conclusions:
- Persistent elevated E/e' and LVSD are key indicators of declining exercise capacity in SBHF.
- These findings support considering both E/e' and LVSD for distinguishing SBHF from Stage A HF.
- Reversion of LV dysfunction markers is linked to preserved exercise capacity, highlighting potential targets for HF prevention strategies.
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