Increased Proximal Arterial Stiffness and Cardiac Response With Moderate Exercise in Patients With Heart Failure and Preserved Ejection Fraction

• Published in: Journal of the American College of Cardiology Vol. 59; no. 5; pp. 455 - 461
• Main Authors: Tartière-Kesri, Lamia, MD, Tartière, Jean-Michel, MD, Logeart, Damien, MD, PhD, Beauvais, Florence, MD, Cohen Solal, Alain, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 31.01.2012; Elsevier; Elsevier Limited
• Subjects: Aged; arterial stiffness; Biological and medical sciences; Blood Pressure; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Carotid Artery, Common - physiopathology; Compliance; contractility; Correlation analysis; diastole; Echocardiography, Doppler; exercise; Exercise - physiology; Exercise Test; Female; Follow-Up Studies; Fractions; Heart; Heart attacks; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart rate; Humans; Internal Medicine; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Laboratories; Male; Manometry; Medical prognosis; Medical sciences; Mortality; Prognosis; Severity of Illness Index; Stroke Volume - physiology; Vascular Resistance - physiology; Vascular Stiffness; Ventricular Function, Left; arterial stiffness; PP; YEM; E; Peterson's modulus; LVEF; exercise; volume at end-diastolic pressure of 20 mm Hg indexed to body surface area; LV; Ep; HFpEF; pulse wave velocity; PVR; left ventricular ejection fraction; V20 i; EDP; heart failure with preserved ejection fraction; end-diastolic pressure; EDV; end-diastolic volume; left ventricular; peripheral vascular resistance; 6-MWT; 6-min walking test; diastole; heart failure; pulse pressure; SV; peak velocity of the early diastolic mitral inflow divided by E; contractility; Young's elastic modulus; Ees after normalization for the left ventricular mass and V0; Ees- LVM-V0; mitral annular early diastolic velocity; PWV; stroke volume; Ees; arterial elastance; end-systolic elastance; E/E; Ea; HF; Ees-LVM-V0; V20i; Heart; Physical exercise; Human; Heart failure; Proximal; Cardiovascular disease; Patient; Artery; Response; Heart disease; Exercise tolerance test; Stiffness; Circulatory system; Hemodynamics; Cardiology; Ejection fraction
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2011.10.873

Objectives This study sought to demonstrate that arterial stiffness is probably underestimated in patients with heart failure with preserved ejection fraction (HFpEF) at rest and may be revealed with moderate exercise. Background HFpEF is associated with ventriculoarterial stiffening. Methods We compared 23 patients with stable chronic HFpEF, left ventricular ejection fraction >45%, and impaired relaxation with 15 controls without cardiac disease. Patients were compared at rest and during a 30-W exercise. The following variables were measured or calculated by Doppler echocardiography and tonometry: left ventricular volumes and end-systolic elastance (Ees), peripheral resistance, arterial elastance (Ea), arterial compliance, aortic pulse wave velocity, and carotid Peterson modulus (Ep). Results Patients with HFpEF were comparable to controls in age, sex ratio, blood pressure, and heart rate. Ventriculoarterial coupling, assessed by Ees/Ea and Ees/Ep ratios, was moderately impaired at rest in patients compared with controls (both p < 0.01). HFpEF was associated during exercise with a major increase in Ep (+155 ± 193% vs. −5 ± 28%), pulse wave velocity (+20 ± 30% vs. −7 ± 24%), and Ea (+12 ± 15% vs. −5 ± 10%), and a lower decrease in peripheral resistance (−17 ± 12% vs. −26 ± 12%) (p < 0.05 for all). In addition, HFpEF patients showed a lower increase in stroke volume (+10 ± 16% vs. +21 ± 12%) despite a greater increase in Ees (+20 ± 18% vs. +3 ± 12%) (p < 0.05 for all). Also during exercise, adaptation of proximal ventriculoarterial coupling was impaired in HFpEF patients (Ees/Ep: −26 ± 47% vs. +20 ± 47% for controls) (p < 0.01), with no difference in Ees/Ea. Conclusions In HFpEF patients, moderate exercise leads to a steep increase in proximal afterload that is underestimated at rest and is associated with unfavorable ventriculoarterial coupling and exercise intolerance.