Background Many patients presenting with symptoms of heart failure are found to have normal ejection fraction using standard 2D echocardiography and are labelled as having Diastolic Heart Failure or HFNEF. It is known that apical rotation is reduced at rest and on exercise in these patients. But there are no data on basal rotation and hence torsion on exercise in this group of patients.
Method Thirty-five Patients (age 73±7 years, 25 female) with breathlessness on exertion and normal EF (60±6%) underwent cardiopulmonary exercise test to rule out alternative clinical reasons (VO2max 18.4±4.9 ml/min/kg). Data were compared to 26 age-matched control subjects (age 72±7 years, 20 female, EF 61±7%) with a normal exercise tolerance (VO2max 29.5±5.2 ml/min/kg). All underwent full Doppler 2D-echocardiography at rest and on supine exercise. Echo images were analysed off-line. Rotation was measured by speckle tracking from parasternal short axis views at mitral valve and apical level. Subsequently LV torsion was calculated as the difference of rotation at apex and at base in six interpolated (three for apical, three for basal rotation) cycles by a specially developed software.
Results All results for rest and exercise are presented in the Abstract 62 Table 1.
At rest apical but not basal rotation was significantly reduced in patients. On exercise apical and basal rotation were both significantly reduced which lead to a severely impaired torsion in patients. This correlated with E/e' (an index of LV filling pressures) on exercise (Pearson Coefficient –0.388, p=0.005).
Conclusion Patients with HFNEF show a marked reduction in torsion particularly on exercise due to the inability to improve neither apical nor basal rotation. Since this correlates well with E/E' it might explain in part the breathlessness on exertion in these patients.
- heart failure with normal ejection fraction
- speckle tracking