Abstract 15435: Myocardial Deformation at Rest Predicts Exercise-induced Elevation in Left Ventricular Filling Pressure in Patients With Exertional Dyspnea

Abstract

Background: An exaggerated rise in the pulmonary arterial wedge pressure (PAWP) with exercise is a hallmark of heart failure. However, conventional resting-state measures of cardiac structure and function poorly predict exercise hemodynamics. We determined whether LV longitudinal strain (LS) and circumferential strain (CS) predict exercise-induced rise in PAWP. Methods: We studied 85 patients referred for cardiopulmonary exercise testing with invasive hemodynamic monitoring for evaluation of dyspnea. Patients with an LVEF<50% or moderate or greater valvular disease were excluded. All patients underwent rest echocardiography followed by exercise testing with invasive hemodynamic monitoring. Global longitudinal strain (LS), global circumferential strain (CS) and the CS/LS-ratio were measured by 2D speckle-tracking echocardiography. Results: Mean age was 53±18 years, 25% were male, 41% had hypertension, and 9% had diabetes mellitus. Lower absolute LS at rest was associated with greater increase in PAWP during exercise (r=0.23, p=0.033). In contrast, higher absolute CS at rest predicted a greater increase in PAWP (r=-0.27, p=0.025) and greater increase in stroke volume with exercise (r=-0.26, p=0.044). Higher CS/LS-ratio was most predictive of elevation in PAWP with exercise (r=0.27, p=0.023; Figure). Conclusion: Myocardial deformation at rest predicts exercise-induced rise in PAWP among patients with dyspnea and a preserved LVEF. A pattern of rest deformation characterized by worse LS and exaggerated CS is most strongly associated with exercise-induced rise in PAWP.