Dyspnea of Cardiac Origin in 67-Year-Old Men: Relation to Clinical and Noninvasive Measures of Cardiac Function

Abstract

The relation of presumed cardiac dyspnea to regional (presence of akinesia), systolic (fractional shortening), and diastolic (left atrial dimension, atrial emptying index, and heart rate adjusted A2 to O-point interval) cardiac dysfunction, as well as to nonspecific heart function indices (mitral valve E-point to septal separation and exercise test) and clinical information, was investigated in a sample from the general population. We selected, from a screened cohort of 644 67-year-old men, 42 subjects with presumed cardiac dyspnea and chose at random 45 nondyspneic controls. In univariate analysis the degree of dyspnea was most closely related to the E-point to septal separation (r = 0.58, p < 0.0001) and to presence of akinetic segments (r = 0.53, p < 0.0001). Clinical and noninvasive findings were compared in multivariate stepwise regression analysis, and, in order of significance, the E-point to septal separation, presence of akinetic segments, exercise capacity, history of angina pectoris and left atrial dimension contributed independently to the explanation of the dyspnea grade variance. Together they explained 74%. Of the 37 men with mild to moderate dyspnea, 27% had systolic dysfunction as evidenced by a low fractional shortening. Diastolic abnormalities and/or akinetic segments with normal fractional shortening were found in 44%. Increased E-point to septal separation was the only abnormality in 11 %, while 18 % had no detectable abnormality. The 5 men with severe dyspnea had several abnormalities, low fractional shortening being present in 4 men. Thus, severe dyspnea was associated with combinations of abnormalities, while, in men with mild to moderate dyspnea, diastolic dysfunction and/or akinetic segments were more prevalent than low fractional shortening, a finding with potential therapeutic implications. The mitral E-point to septal separation was found to be the measure most likely of those studied to reveal cardiac dysfunction as causing dyspnea.