Determinants of submaximal exercise capacity in patients at risk for heart failure with preserved ejection fraction—results from the DIAST‐CHF study

ESC Heart Failure

Raoul Stahrenberg⁷  André Duvinage⁶  Meinhard Mende³  Götz Gelbrich⁴  Wiebke auf der Heide⁷  Hans-Dirk Düngen⁵  Lutz Binder²  Kathleen Nolte⁷  Christoph Herrmann-Lingen¹  Gerd Hasenfuß⁷  Burkert Pieske⁵  Rolf Wachter⁷ 

[1]Department of Psychosomatic Medicine and Psychotherapy, Göttingen University Medical Center, Göttingen, Germany

[2]Department of Clinical Chemistry, Göttingen University Medical Center, University of Göttingen, Göttingen, Germany

[3]Center for Clinical Trials, University of Leipzig, Leipzig, Germany

[4]Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany

[5]Department of Cardiology, Charité–Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany

[6]Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany

[7]Department of Cardiology and Pneumology, Göttingen University Medical Center, Göttingen, Germany

关键词: Exercise capacity;    Diastolic dysfunction;    Biomarkers;   

DOI  :  10.1002/ehf2.12034

来源: Wiley

【 摘 要 】

Abstract

Objectives and Background

The aim of this study was to identify determinants of submaximal exercise capacity as measured by 6 min walking distance in patients at risk for heart failure with preserved ejection fraction (HFpEF).

Methods

A cross-sectional analysis from the prospective cohort programme Prevalence and Clinical Course of Diastolic Dysfunction and Heart Failure (DIAST-CHF) that included a total of 1937 patients (age, 50–85 years) with >1 risk factor (hypertension, atherosclerotic disease, diabetes mellitus, and obstructive sleep apnoea) was carried out. Besides comprehensive clinical phenotyping, standardized 6 min walk test and state-of-the-art echocardiography were performed, and blood samples for biomarker assessment were obtained. Patients with an ejection fraction <50% or without evaluable exercise test were excluded from this analysis.

Results

One thousand three hundred eighty-seven patients fulfilled all criteria for this analysis. In the univariate analysis, 6 min walk distance was inversely related to E/e′ values (P < 0.001). In the multivariate analysis, 6 min walk distance decreased significantly with age, female sex, increasing body mass index, diabetes, chronic obstructive lung disease, and peripheral artery disease. However, the association of 6 min walk distance with resting parameters of diastolic function was significantly attenuated with multivariate regression. In contrast, mid-regional pro-adrenomedullin, mid-regional pro-atrial natriuretic peptide, and N-terminal pro-B-type natriuretic peptide were independently associated with submaximal exercise capacity when added to the base model (all P < 0.001).

Conclusions

Classical risk factors for heart failure and neuroendocrine activation are independently associated with sub-maximal exercise capacity, while diastolic function parameters obtained at rest were not. This observation substantiates the role of co-morbidities as relevant contributors to the clinical picture of HFpEF and the limitation of resting indices of diastolic function for diagnosing HFpEF.

【 授权许可】

CC BY-NC-ND   
© 2015 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.