Relation of ventricular-vascular coupling to exercise capacity in ischemic cardiomyopathy: a cardiac multi-modality imaging study

Int J Cardiovasc Imaging. 2010 Feb;26(2):151-9. doi: 10.1007/s10554-009-9516-4. Epub 2009 Oct 13.

Abstract

The purpose of this study was to examine the relationship between noninvasive measurements of ventricular-vascular coupling (VVC) with exercise tolerance, and compared the value of VVC versus other traditional determinants of exercise capacity in this population. 43 patients with ischemic CMP (age 59 +/- 9 years, mean EF 24 +/- 8%) underwent cardiopulmonary exercise testing, echocardiography and cardiac magnetic resonance (CMR). VVC was defined non-invasively by the ratio of ventricular systolic elastance (Ees) to the arterial elastance (Ea), where Ees = end-systolic pressure/end-systolic volume index and Ea = end-systolic pressure/stroke volume index. VVC significantly correlated with baseline heart rate (HR), peak exercise systolic blood pressure, maximum oxygen consumption (MVO(2)) and peak O(2) pulse (MVO(2)/HR). A higher VVC was associated with higher LVEF and RVEF but showed inverse relation to mitral E wave velocity. Univariate predictors of MVO(2) are baseline HR, chronotropic reserve, VVC and aortic distensibility; whilst mitral E wave velocity, LVEF, VVC, Ees significantly correlated with peak O(2) pulse. By stepwise multivariate analysis, VVC remained the only independent predictor of peak O(2) pulse. Ventricular-vascular coupling at rest may be a clinically important parameter in predicting exercise capacity in patients with advanced heart failure, and may become an additional target for therapeutic interventions.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aorta / physiopathology*
  • Cardiomyopathies / diagnosis
  • Cardiomyopathies / etiology
  • Cardiomyopathies / physiopathology*
  • Cardiomyopathies / surgery
  • Echocardiography, Doppler, Color
  • Echocardiography, Doppler, Pulsed
  • Elasticity
  • Exercise Test
  • Exercise Tolerance*
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / etiology
  • Heart Failure / physiopathology*
  • Heart Failure / surgery
  • Heart Rate
  • Heart Transplantation
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Myocardial Ischemia / complications
  • Myocardial Ischemia / diagnosis
  • Myocardial Ischemia / physiopathology*
  • Myocardial Ischemia / surgery
  • Observer Variation
  • Oxygen Consumption
  • Predictive Value of Tests
  • Reproducibility of Results
  • Stroke Volume
  • Ventricular Function, Left*
  • Ventricular Function, Right
  • Ventricular Pressure