Effect of Left Ventricular Diastolic Dysfunction on the Cardiopulmonary Exercise Test in Patients With Cardiovascular Disease

• Published in: The American journal of cardiology 2024-07, Vol.222, p.157-164
• Main Authors: Inada, Yuki, Suematsu, Yasunori, Matsuda, Takuro, Yano, Yuiko, Morita, Kai, Bando, Kakeru, Teshima, Reiko, Fukuda, Hiroyuki, Fujimi, Kanta, Miura, Shin-Ichiro
• Format: Article
• Language: English
• Subjects: Aged; Anaerobic threshold; Blood pressure; Body mass index; Body size; Body weight; Carbon dioxide; cardiopulmonary exercise test; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - physiopathology; Congestive heart failure; Diastole; Diuretics; Echocardiography; Ejection fraction; Exercise; Exercise Test - methods; Exercise Tolerance - physiology; Female; Gender; Heart failure; Heart rate; Hemodynamics; Humans; Ischemia; left ventricular diastolic dysfunction; Male; Metabolic disorders; Middle Aged; Morbidity; Normal distribution; Oxygen; Oxygen consumption; Oxygen Consumption - physiology; Oxygen uptake; Parameters; Patients; Peak periods; Peptides; Physical fitness; Prognosis; Retrospective Studies; Stroke Volume - physiology; Velocity; ventilatory inefficiency; Ventricle; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2024.04.055

•Diastolic dysfunction can be present even in the setting of reduced left ventricular ejection fraction.•The effect of left ventricular diastolic dysfunction on the exercise test results was investigated.•Left ventricular diastolic dysfunction affects ventilatory efficacy in the exercise test.•Low ventilatory efficacy could contribute to a poor prognosis in heart failure. Left ventricular diastolic dysfunction exists in patients with heart failure with reduced ejection fraction and causes activity restriction and a poor prognosis, but there have been few reports about exercise tolerance in patients with diastolic dysfunction, regardless of left ventricular ejection fraction (LVEF). In this study, 294 cardiovascular disease patients who performed a cardiopulmonary exercise test (CPX) with an adequate examination by echocardiography at Fukuoka University Hospital from 2011 to 2020 were investigated. Patients were divided into groups with grade I and grade II or III diastolic dysfunction according to diagnostic criteria, regardless of LVEF, by echocardiography. After adjusting for age, gender, body mass index, smoking, and LVEF by propensity score matching, we compared the results of CPX between the grade I and grade II/III groups. There were no significant differences in hemodynamic parameters, or in the respiratory exchange ratio, oxygen uptake per body weight, oxygen uptake per heart rate, or parameters of ventilatory volume. Ventilatory equivalents per oxygen uptake and per carbon dioxide output were significantly worse in the grade II/III group from the rest to peak periods during CPX. In conclusion, left ventricular diastolic dysfunction worsens ventilatory efficacy during CPX. This effect potentially contributes to a poor prognosis in left ventricular diastolic dysfunction.