Pathophysiologic and prognostic importance of cardiac power output reserve in heart failure with preserved ejection fraction

Daiki Takizawa, Tomonari Harada, Masaru Obokata, Kazuki Kagami, Hidemi Sorimachi, Naoki Yuasa, Yuki Saito, Fumitaka Murakami, Ayami Naito, Toshimitsu Kato, Naoki Wada, Hideki Ishii

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Heart failure with preserved ejection fraction (HFpEF) is a syndrome characterized by multiple cardiac reserve limitations during exercise. Cardiac power output (CPO) is an index of global cardiac performance and can be estimated non-invasively by echocardiography. We hypothesized that CPO reserve during exercise would be associated with impaired cardiovascular reserve, exercise intolerance, and adverse outcomes in HFpEF. Methods and results: Exercise stress echocardiography was performed in 425 dyspnoeic patients [217 HFpEF and 208 non-heart failure (HF) controls] to estimate CPO at rest and during exercise. We classified patients with HFpEF based on the median value of changes in CPO from rest to peak exercise (ΔCPO >0.49 W/100 g). Patients with HFpEF and a lower CPO reserve had poorer biventricular systolic function, impaired chronotropic response during exercise, and worse aerobic capacity than controls and those with a higher CPO reserve. During a median follow-up of 358 days, a composite outcome of all-cause mortality or HF events occurred in 30 patients. Patients with a lower CPO reserve had four-fold and nearly 10-fold increased risks of the outcomes compared with those with a higher CPO reserve and controls, respectively [hazard ratio (HR) 4.05, 95% confidence interval (CI) 1.16-10.1, P = 0.003 and HR 9.61, 95% CI 3.58-25.8, P < 0.0001]. We further found that a lower CPO reserve had an incremental prognostic value over the H2FPEF score and exercise duration. In contrast, resting CPO did not predict clinical outcomes in patients with HFpEF. Conclusion: A lower CPO reserve was associated with biventricular systolic dysfunction, chronotropic incompetence, exercise intolerance, and adverse outcomes in patients with HFpEF.

Original languageEnglish
Pages (from-to)220-228
Number of pages9
JournalEuropean Heart Journal Cardiovascular Imaging
Volume25
Issue number2
DOIs
Publication statusPublished - 1 Feb 2024

Keywords

  • cardiac power output
  • echocardiography
  • exercise
  • heart failure with preserved ejection fraction
  • prognosis

Fingerprint

Dive into the research topics of 'Pathophysiologic and prognostic importance of cardiac power output reserve in heart failure with preserved ejection fraction'. Together they form a unique fingerprint.

Cite this