Cardiac reserve and exercise capacity: insights from combined cardiopulmonary and exercise echocardiography stress testing

Abstract Funding Acknowledgements Type of funding sources: None. Aims. Combined cardiopulmonary exercise test (CPET) and stress echocardiography (ESE) provides a non-invasive tool to study pathophysiology. We analyzed how cardiac functional reserve during relates peak oxygen consumption (VO2). Methods Results. performed symptom-limited graded ramp bicycle CPET-ESE in 30 healthy controls 357 patients: 113 at risk developing heart failure (American College Cardiology/American Heart Association HF Stages A-B) 244 Stage C with preserved (HFpEF, n = 101) or reduced ejection fraction (HFrEF, 143). Peak VO2 significantly decreased from A-B (Table 1). A multivariable regression model predict revealed left ventricular systolic annulus tissue velocity (S"), TAPSE/PAPs (tricuspid annular plane excursion/systolic pulmonary artery pressure) low-load atrial reservoir strain/E/e’ were independent predictors, addition rate, stroke volume workload (adjusted R²=0.76, p < 0.0001). The was successfully tested subjects fibrillation (n 49), 224) without 163) beta-blockers (all 0.01). S’ showed the highest accuracy predicting 10 mL/kg/min (cut-point ≤ 7.5 cm/s; AUC 0.92, 0.0001) > 20 12.5 0.84, comparison other variables (p 0.05). Conclusions. incorporating different measures mechanics is strongly related aerobic capacity may help identifying causes effort intolerance C. Table 1 Variable Overall population 387) Controls 30) 113) C-HFpEF c-HFrEF 143) p-value Age, years 68.9 ± 11.1 67.1 10.6 67.7 10.4 70.5 10.1 68.5 11 0.1 Male, (%) 247 (64) 18 (60) 70 (62) 57 (56) 102 (71) @peak, mL/min/kg 15.7 (12.1-19.6) 23 (21.7- 29.7) (15.4- 20.7)* 13.6 (11.8- 16.8)*† 14.2 (10.7- 17.5)*† <0.0001 Workload W 90 (65-120) 130 (115-195) 110 (84-130)* (55-100)*† 80 (60-110)*† rate bpm 123 22 142 12 20* 115 17*† 119 23*† Stroke mL 83 (71-99) 98 (85-114) 86 (76-107) (74-97)* 75 (63-95)*† Average S" cm/s 11.2 3.8 17.1 3.9 13.3 2.9* 2.5*† 8.7 2.7*†‡ mm/mmHg 0.75 (0.46-0.97) 1.05 (0.93- 1.16) 0.81 (0.52- 0.91)* 0.52 (0.38- 0.83)*† 0.58 (0.41- 0.89)*† Left strain/E/e" @low-load, % 2.25 (1.17-5.04) 6.23 (4.45-6.77) 4.34 (3.89- 5.58)* 2.23 (1.31- 2.86)*† 1.91 (1.07-2.44)*†‡ * 0.01 vs Controls; † A-B; ‡ C-HFpEF. PAPs pressure; TAPSE: tricuspid excursion; VO2: consumption. Figure