Value of exercise echocardiography in heart failure with preserved ejection fraction: a substudy from the KaRen study.
BACKGROUND KaRen is a multicentre study designed to characterize and follow patients with heart failure and preserved ejection fraction (HFpEF) In a subgroup of patients with clinical signs of congestion but left ventricular ejection fraction (LVEF) >45% we sought to describe and analyse the potential prognostic value of echocardiographic parameters recorded not only at rest but also during a submaximal exercise stress echocardiography. Exercise induced changes in echo parameters might improve our ability to characterize HFpEF patients. METHOD AND RESULTS Patients were prospectively recruited in a single tertiary centre following an acute HF episode with NT pro BNP >300 pg/mL (BNP 100 pg/mL) and LVEF 45% and reassessed by exercise echo Doppler after 4 8 weeks of dedicated treatment. Image acquisitions were standardized, and analysis made at end of follow up blinded to patients' clinical status and outcome. In total, 60 patients having standardized echocardiographic acquisitions were included in the analysis. Twenty six patients (43% died or were hospitalized for HF (primary outcome) The mean SD workload was 45 14 watts (W) Mean SD resting LVEF and LV global longitudinal strain was 57.6 9.5% and 14.5 4.2% respectively. Mean SD resting E/e' was 11.3 4.7 and 13.1 5.3 in those patients who did not and those who did experience the primary outcome, respectively (P 0.03) Tricuspid regurgitation (TR) peak velocity during exercise were 3.3 0.5 and 3.7 0.5 m/s (P 0.01) Exercise TR was independently associated with HF hospitalization or death after adjustment on baseline clinical and biological characteristics. CONCLUSION Exercise echocardiography may contribute to identify HFpEF patients and especially high risk ones. Our study suggested a prognostic value of TR recorded during an exercise. That was demonstrated independently of the value of resting E/e'
European heart journal cardiovascular Imaging