| 研究実績の概要 |
Background: Determinants of exercise intolerance in a phenotype of heart failure with preserved ejection fraction (HFpEF) with normal left ventricular (LV) structure have not been fully elucidated.
Methods: Cardiopulmonary exercise testing and exercise-stress echocardiography were performed in 49 HFpEF patients without LV hypertrophy. Exercise capacity was determined by peak oxygen consumption (peak VO2). Doppler-derived cardiac output (CO), transmitral E velocity, systolic (LV-s) and early diastolic mitral annular velocities (e), systolic pulmonary artery (PA) pressure (SPAP), tricuspid annular plane systolic excursion (TAPSE), and peak systolic right ventricular (RV) free wall velocity (RV-s) were measured at rest and exercise. E/e and TAPSE/SPAP were used as an LV filling pressure parameter and RV-PA coupling, respectively.
Results: During exercise, CO, LV-s, RV-s, e, and SPAP were significantly increased (P<0.05 for all), whereas E/e remained unchanged and TAPSE/SPAP was significantly reduced (P<0.001). SPAP was higher and TAPSE/SPAP was lower at peak exercise in patients showing lower-half peak VO2. In univariable analyses, LV-s (R=0.30, P=0.0387), SPAP (R=－0.38, P=0.0078), RV-s (R=0.40, P=0.0061), and TAPSE/SPAP (R=0.41, P=0.0034) were significantly correlated with peak VO2. In multivariable analyses, not only SPAP, but also TAPSE/SPAP independently determined peak VO2 even after the adjustment for clinically relevant parameters.
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