Evaluation of exercise capacity using wave intensity in chronic heart failure with normal ejection fraction

Impaired exercise capacity has been found in patients with diastolic dysfunction with preserved systolic function. Although conventional transthoracic echocardiography (TTE) provides useful clinical information about systolic and diastolic cardiac function, its capability to evaluate exercise capacity has been controversial. The inertia force of late systolic aortic flow is known to have a tight relationship with left ventricular (LV) performance during the period from near end-systole to isovolumic relaxation. The inertia force and the time constant of LV pressure decay during isovolumic relaxation can be estimated noninvasively using the second peak (W₂) of wave intensity (WI), which is measured with an echo-Doppler system. We sought to determine whether W₂ is associated with exercise capacity in patients with chronic heart failure with normal ejection fraction (HFNEF) and to compare its ability to predict exercise capacity with parameters obtained by conventional TTE including tissue Doppler imaging. Sixteen consecutive patients with chronic HFNEF were enrolled in this study. Wave intensity was obtained with a color Doppler system for measurement of blood velocity combined with an echo-tracking system for detecting changes in vessel diameter. Concerning conventional TTE, we measured LV ejection fraction (EF), peak velocities of early (E) and late (A) mitral inflow using pulse-wave Doppler, and early (Ea) and late (Aa) diastolic velocities using tissue Doppler imaging. Left ventricular EF, E/A ratio, Ea, and E/Ea ratio did not correlate with exercise capacity, whereas W₂ significantly correlated with peak VO₂ (r = 0.54, p = 0.03), VE/VCO₂ slope (r = −0.53, p = 0.03), and ΔVO₂/ΔWR (r = 0.56, p = 0.02). W₂ was associated with exercise capacity in patients with chronic HFNEF. In conclusion, W₂ is considered to be clinically more useful than conventional TTE indices for evaluating exercise capacity in patients with chronic HFNEF.