Cor Vasa 2011, 53(3):124-129 | DOI: 10.33678/cor.2011.027

The prognostic value of left ventricular filling pressure during exercise in heart failure patients

Zbyněk Pozdíšek^1,*, Kateřina Langová²

¹ Kardiochirurgická klinika, Fakultní nemocnice Olomouc a Lékařská fakulta Univerzity Palackého

² Ústav lékařské biofyziky, Lékařská fakulta Univerzity Palackého, Olomouc, Česká republika

Aim: To assess the value of exercise tissue Doppler echocardiography in the prognostic stratification of patients with congestive heart failure with impaired systolic function.

Patients and methods: We enrolled 106 patients with congestive heart failure and LVEF ≤ 45% on optimal pharmacotherapy. The patients underwent blood sampling for BNP level analysis, resting echocardiographic examination, cardiopulmonary exercise test using bicycle ergometry, and a post-exercise echocardiographic study. We formed two groups of patients according to their prognostic classification. Group I included 21 patients with a poor prognosis defined as predicted value of pVO2 < 76%, together with both VE/VCO2 slope > 32.7 pg/ml and BNP > 210 pg/ml, and Group II with 85 patients not meeting the above criteria for poor prognosis.

Results: There were significant differences in indexed left atrial volume, mitral regurgitation severity, systolic mitral annulus velocity at rest and after exercise, and in E/Em at rest and in E'/Em' after exercise. Multivariate analysis identified E/Em as the only independent predictor of prognosis. An E/Em at rest (after exercise) ≥ 16.6 (18.7) identified a poor prognosis with a sensitivity of 71% (86%) and specificity of 71% (71%).

Conclusion: Exercise tissue Doppler echocardiography may be superior to resting parameters in the prognostic stratification of patients with congestive heart failure.

Keywords: Exercise echocardiography; Heart failure; Prognosis

Published: March 1, 2011  Show citation