The study is partly supported by grants from National Science Council Taiwan: NSC 99-2314-B-002-116-MY3.
Impacts of Mitral E/e′ on Myocardial Contractile Motion and Synchronicity in Heart Failure Patients With Reduced Ejection Fraction: An Exercise–Echocardiography Study
Article first published online: 13 MAY 2013
© 2013 Wiley Periodicals, Inc.
Volume 36, Issue 8, pages 462–467, August 2013
How to Cite
Wang, Y.-C., Yu, C.-C., Chiu, F.-C., Tsai, C.-T., Lai, L.-P., Hwang, J.-J. and Lin, J.-L. (2013), Impacts of Mitral E/e′ on Myocardial Contractile Motion and Synchronicity in Heart Failure Patients With Reduced Ejection Fraction: An Exercise–Echocardiography Study. Clin Cardiol, 36: 462–467. doi: 10.1002/clc.22141
The authors have no other funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 12 AUG 2013
- Article first published online: 13 MAY 2013
- Manuscript Accepted: 15 APR 2013
- Manuscript Received: 20 FEB 2013
The association between diastolic abnormality and postexercise contractile decompensation is uncertain in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF).
The higher mitral E/annular early diastolic velocity (E/e′) is relevant to postexercise regional myocardial contractile maladaptation.
Seventy HF patients with LVEF <50 % (56 males, 58 ± 15 years) were studied pre- and postexercise using tissue Doppler echocardiography. We evaluated the mean and standard deviation of systolic myocardial velocity (Sm) and electromechanical delay (Ts) of 12 left ventricular segments, and further analyzed the corresponding changes of septal and posterolateral segments.
The higher mitral E/e′ was associated with more blunted heterogeneity of Sm and greater ventricular dyssynchrony after exercise. This is due to the posterolateral wall not being able to increase Sm with exercise to the same degree as the septum (decreased posterolateral/septal Sm ratio). Furthermore, the postexercise aggravated difference of Ts between septum and posterolateral segments leads to more dyssynchronous contraction in the higher E/e′ groups. An E/e′ ≥10 predicted a postexercise posterolateral/septal Sm ≤ 1 (odds ratio [OR]: 5.8, 95% confidence interval [CI]: 1.5-22.6, P = 0.011), and a difference of Ts between septum and posterolateral segments >65 ms (OR: 64, 95% CI: = 6–651, P < 0.001) in HF patients with reduced LVEF in multivariate analysis.
The higher mitral E/e′-related postexercise maladaptation of myocardial contractile motion and synchronicity suggests the involvement of systolic abnormality in exercise pathophysiology in HF patients with reduced LVEF.