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What influences exercise capacity in male and female with heart failure and preserved ejection fraction of left ventricle?
1National O.O. Bohomolets Medical University, Department Internal Medicine - Kiev - Ukraine
The evaluation of the ability of an individual to perform exercise appears to be one of the strongest criteria of patient’s subjective and objective well-being. However, factors observed in patients with HFpEF that alter exercise capacity are not unified and can be different dependently on gender.
Purpose. To reveal the link between echocardiographic parameters or laboratory tests and the results of 6-minute walk test n male and female with HFpEF, paying the most attention at diastolic function of left ventricle (LV).
Materials and methods. We consequently enrolled 54 patients with signs and symptoms of chronic HF II and III class NYHA at the moment of admission. Transthoracic 2D Echocardiography and tissue Doppler were performed to confirm LV diastolic dysfunction (criteria: LV ejection fraction (LVEF)>45%, left atrium diameter (dLA)>40 mm, LVMI >115 g/m² , E/e’>13). Plasma NT-proBNP level was evaluated to establish HFpEF; arterial elastance (Ea) and ventricular elastance (Ees) were calculated. 6-minute walk test was performed according to "ATS Statement: Guidelines for the Six-Minute Walk Test". Patients with proven coronary artery diseases were not included.
Results. 28 women and 26 men were examined. Groups didn’t differ in age (f-71±7,6 vs m-67,3±12,1) and body mass index (BMI) (f-31,5±4,9 vs m- 29,9±5,4), all p>0,05. The correlation analysis revealed an inverse correlation between the LA volume index (LAVI) (f-40,9±6,3; m-42,7±6,9), E/e’ (f-15,1±2,4; m-14,9±1,5), mean pulmonary artery pressure (MPAP) (f-44,6±13,3; m-38,2±11,7), plasma NT-proBNP (f-595,5±430,6; m-673,9±428,3) level and distance of 6MW (f-362,5±65,2; m-433,1±102,3) in both groups of patients; between the right ventricle diameter (dRV) (2,9±0,6), Ea (2,1±0,5) and the distance of 6MW in women; between the age and the distance of 6MW in male. Results are shown in the table.
Conclusions. Such parameters as LAVI, MPAP, E/e’, NT-proBNP correlates significantly with the results of 6MW test independently on gender. Correlation between age and 6MW distance in men can probably be associated with multiple comorbidities that are added with age. In women, correlation between dRV and Ea can be determined by mechanisms that provide a female-specific cardiovascular aetiology in HFpEF, but still it has to be clarified.
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