Abstract
Methods commonly used clinically to assess cardiac function in patients with heart failure include ejection fraction (EF), exercise treadmill testing (ETT), and symptom evaluation. Although these approaches are useful in evaluating patients with heart failure, there are at times substantial mismatches between individual assessments. For example, ETT results are often discordant with EF, and patients with minimal symptoms sometimes have surprisingly low EFs. To better define the relationship of these methods of assessment, we studied 56 patients with heart failure with reduced EF (HFrEF) who underwent measurement of ETT duration, EF by echocardiography, quantitative symptom evaluation, and LV peak dP/dt (rate of left ventricular pressure development and decline, measured invasively). Correlations were determined among these four tests in order to assess the relationship of EF, ETT, and symptoms against LV peak dP/dt. In addition, we sought to determine whether EF, ETT, and symptoms correlated with each other. Overall, correlations were poor. Only 15 of 63 total correlations (24%) were significant (p < 0.05). EF correlated most closely with LV peak -dP/dt. Linear regression analysis indicated that EF, ETT, and symptoms taken together predicted LV peak dP/dt better than any one measure alone. We conclude that clinical tests used to assess LV function in patients with HFrEF may not be as accurate or correlate as well as expected. All three clinical measures considered together may be the best representation of cardiac function in HFrEF patients currently available.
Highlights
Heart failure (HF) is the most common diagnosis for nonelective hospitalization in individuals over the age of 65 in the US [1] and is increasing in prevalence
The present study examines the correlations among four important measures used to assess LV function in patients with HF: exercise treadmill testing (ETT), ejection fraction (EF), symptoms, and LV peak dP/dt
Overall this study indicates that surrogate measures of LV function in patients with heart failure with reduced EF (HFrEF) are not tightly correlated with LV peak +dP/dt, used as a relative gold standard of LV contractile function
Summary
Heart failure (HF) is the most common diagnosis for nonelective hospitalization in individuals over the age of 65 in the US [1] and is increasing in prevalence. The focus of the current study is to evaluate how well these tests relate to one another and how accurately they predict left
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