Comparisons of Noninvasive Methods Used to Assess Exercise Stroke Volume in Heart Failure with Preserved Ejection Fraction

Erik H. Van Iterson, Thomas P Olson, Barry A Borlaug, Bruce David Johnson, Eric M. Snyder

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction Cardiopulmonary exercise testing (CPET) plays an important role in properly phenotyping signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The prognostic value of CPET is strengthened when accompanied by cardiac hemodynamic measurements. Although recognized as the "gold" standard, cardiac catheterization is impractical for routine CPET. Thus, advancing the scientific/methodologic understanding of noninvasive techniques for exercise cardiac hemodynamic assessment is clinically impactful in HFpEF. This study tested the concurrent validity of noninvasive acetylene gas (C2H2) uptake, echocardiography (ECHO), and oxygen pulse (O2pulse) for measuring/predicting exercise stroke volume (SV) in HFpEF. Methods Eighteen white HFpEF and 18 age-/sex-matched healthy controls participated in upright CPET (ages, 69 ± 9 yr vs 63 ± 9 yr). At rest, 20 W, and peak exercise, SV was measured at steady-state via C2H2 rebreathe (SVACET) and ECHO (SVECHO), whereas O2pulse was derived (=VO2/HR). Results Resting relationships between SVACET and SVECHO, SVECHO and O2pulse, or SVACET and O2pulse were significant in HFpEF (R2 = 0.30, 0.36, 0.67), but not controls (R2 = 0.07, 0.01, 0.09), respectively. Resting relationships persisted to 20 W in HFpEF (R2 = 0.70, 0.53, 0.70) and controls (R2 = 0.05, 0.07, 0.21), respectively. Peak exercise relationships were significant in HFpEF (R2 = 0.62, 0.24, 0.64), but only for SVACET versus O2pulse in controls (R2 = 0.07, 0.04, 0.33), respectively. Standardized standard error of estimate between techniques was strongest in HFpEF at 20 W: SVACET versus SVECHO = 0.57 ± 0.22; SVECHO versus O2pulse = 0.71 ± 0.28; SVACET versus O2pulse = 0.56 ± 0.22. Conclusions Constituting a clinically impactful step towards construct validation testing, these data suggest SVACET, SVECHO, and O2pulse demonstrate moderate-to-strong concurrent validity for measuring/predicting exercise SV in HFpEF.

Original languageEnglish (US)
Pages (from-to)1758-1768
Number of pages11
JournalMedicine and Science in Sports and Exercise
Volume49
Issue number9
DOIs
StatePublished - Sep 1 2017

Fingerprint

Stroke Volume
Heart Failure
Echocardiography
Hemodynamics
Acetylene
Cardiac Catheterization
Gold
Signs and Symptoms
Cohort Studies
Gases
Oxygen

Keywords

  • CARDIAC OUTPUT
  • CPET
  • ECHOCARDIOGRAPHY
  • HEART FAILURE WITH PRESERVED EJECTION FRACTION
  • INERT GAS BREATHING

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

@article{d6979f42c7584ed4b723ced9826f877e,
title = "Comparisons of Noninvasive Methods Used to Assess Exercise Stroke Volume in Heart Failure with Preserved Ejection Fraction",
abstract = "Introduction Cardiopulmonary exercise testing (CPET) plays an important role in properly phenotyping signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The prognostic value of CPET is strengthened when accompanied by cardiac hemodynamic measurements. Although recognized as the {"}gold{"} standard, cardiac catheterization is impractical for routine CPET. Thus, advancing the scientific/methodologic understanding of noninvasive techniques for exercise cardiac hemodynamic assessment is clinically impactful in HFpEF. This study tested the concurrent validity of noninvasive acetylene gas (C2H2) uptake, echocardiography (ECHO), and oxygen pulse (O2pulse) for measuring/predicting exercise stroke volume (SV) in HFpEF. Methods Eighteen white HFpEF and 18 age-/sex-matched healthy controls participated in upright CPET (ages, 69 ± 9 yr vs 63 ± 9 yr). At rest, 20 W, and peak exercise, SV was measured at steady-state via C2H2 rebreathe (SVACET) and ECHO (SVECHO), whereas O2pulse was derived (=VO2/HR). Results Resting relationships between SVACET and SVECHO, SVECHO and O2pulse, or SVACET and O2pulse were significant in HFpEF (R2 = 0.30, 0.36, 0.67), but not controls (R2 = 0.07, 0.01, 0.09), respectively. Resting relationships persisted to 20 W in HFpEF (R2 = 0.70, 0.53, 0.70) and controls (R2 = 0.05, 0.07, 0.21), respectively. Peak exercise relationships were significant in HFpEF (R2 = 0.62, 0.24, 0.64), but only for SVACET versus O2pulse in controls (R2 = 0.07, 0.04, 0.33), respectively. Standardized standard error of estimate between techniques was strongest in HFpEF at 20 W: SVACET versus SVECHO = 0.57 ± 0.22; SVECHO versus O2pulse = 0.71 ± 0.28; SVACET versus O2pulse = 0.56 ± 0.22. Conclusions Constituting a clinically impactful step towards construct validation testing, these data suggest SVACET, SVECHO, and O2pulse demonstrate moderate-to-strong concurrent validity for measuring/predicting exercise SV in HFpEF.",
keywords = "CARDIAC OUTPUT, CPET, ECHOCARDIOGRAPHY, HEART FAILURE WITH PRESERVED EJECTION FRACTION, INERT GAS BREATHING",
author = "{Van Iterson}, {Erik H.} and Olson, {Thomas P} and Borlaug, {Barry A} and Johnson, {Bruce David} and Snyder, {Eric M.}",
year = "2017",
month = "9",
day = "1",
doi = "10.1249/MSS.0000000000001308",
language = "English (US)",
volume = "49",
pages = "1758--1768",
journal = "Medicine and Science in Sports and Exercise",
issn = "0195-9131",
publisher = "Lippincott Williams and Wilkins",
number = "9",

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TY - JOUR

T1 - Comparisons of Noninvasive Methods Used to Assess Exercise Stroke Volume in Heart Failure with Preserved Ejection Fraction

AU - Van Iterson, Erik H.

AU - Olson, Thomas P

AU - Borlaug, Barry A

AU - Johnson, Bruce David

AU - Snyder, Eric M.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Introduction Cardiopulmonary exercise testing (CPET) plays an important role in properly phenotyping signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The prognostic value of CPET is strengthened when accompanied by cardiac hemodynamic measurements. Although recognized as the "gold" standard, cardiac catheterization is impractical for routine CPET. Thus, advancing the scientific/methodologic understanding of noninvasive techniques for exercise cardiac hemodynamic assessment is clinically impactful in HFpEF. This study tested the concurrent validity of noninvasive acetylene gas (C2H2) uptake, echocardiography (ECHO), and oxygen pulse (O2pulse) for measuring/predicting exercise stroke volume (SV) in HFpEF. Methods Eighteen white HFpEF and 18 age-/sex-matched healthy controls participated in upright CPET (ages, 69 ± 9 yr vs 63 ± 9 yr). At rest, 20 W, and peak exercise, SV was measured at steady-state via C2H2 rebreathe (SVACET) and ECHO (SVECHO), whereas O2pulse was derived (=VO2/HR). Results Resting relationships between SVACET and SVECHO, SVECHO and O2pulse, or SVACET and O2pulse were significant in HFpEF (R2 = 0.30, 0.36, 0.67), but not controls (R2 = 0.07, 0.01, 0.09), respectively. Resting relationships persisted to 20 W in HFpEF (R2 = 0.70, 0.53, 0.70) and controls (R2 = 0.05, 0.07, 0.21), respectively. Peak exercise relationships were significant in HFpEF (R2 = 0.62, 0.24, 0.64), but only for SVACET versus O2pulse in controls (R2 = 0.07, 0.04, 0.33), respectively. Standardized standard error of estimate between techniques was strongest in HFpEF at 20 W: SVACET versus SVECHO = 0.57 ± 0.22; SVECHO versus O2pulse = 0.71 ± 0.28; SVACET versus O2pulse = 0.56 ± 0.22. Conclusions Constituting a clinically impactful step towards construct validation testing, these data suggest SVACET, SVECHO, and O2pulse demonstrate moderate-to-strong concurrent validity for measuring/predicting exercise SV in HFpEF.

AB - Introduction Cardiopulmonary exercise testing (CPET) plays an important role in properly phenotyping signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The prognostic value of CPET is strengthened when accompanied by cardiac hemodynamic measurements. Although recognized as the "gold" standard, cardiac catheterization is impractical for routine CPET. Thus, advancing the scientific/methodologic understanding of noninvasive techniques for exercise cardiac hemodynamic assessment is clinically impactful in HFpEF. This study tested the concurrent validity of noninvasive acetylene gas (C2H2) uptake, echocardiography (ECHO), and oxygen pulse (O2pulse) for measuring/predicting exercise stroke volume (SV) in HFpEF. Methods Eighteen white HFpEF and 18 age-/sex-matched healthy controls participated in upright CPET (ages, 69 ± 9 yr vs 63 ± 9 yr). At rest, 20 W, and peak exercise, SV was measured at steady-state via C2H2 rebreathe (SVACET) and ECHO (SVECHO), whereas O2pulse was derived (=VO2/HR). Results Resting relationships between SVACET and SVECHO, SVECHO and O2pulse, or SVACET and O2pulse were significant in HFpEF (R2 = 0.30, 0.36, 0.67), but not controls (R2 = 0.07, 0.01, 0.09), respectively. Resting relationships persisted to 20 W in HFpEF (R2 = 0.70, 0.53, 0.70) and controls (R2 = 0.05, 0.07, 0.21), respectively. Peak exercise relationships were significant in HFpEF (R2 = 0.62, 0.24, 0.64), but only for SVACET versus O2pulse in controls (R2 = 0.07, 0.04, 0.33), respectively. Standardized standard error of estimate between techniques was strongest in HFpEF at 20 W: SVACET versus SVECHO = 0.57 ± 0.22; SVECHO versus O2pulse = 0.71 ± 0.28; SVACET versus O2pulse = 0.56 ± 0.22. Conclusions Constituting a clinically impactful step towards construct validation testing, these data suggest SVACET, SVECHO, and O2pulse demonstrate moderate-to-strong concurrent validity for measuring/predicting exercise SV in HFpEF.

KW - CARDIAC OUTPUT

KW - CPET

KW - ECHOCARDIOGRAPHY

KW - HEART FAILURE WITH PRESERVED EJECTION FRACTION

KW - INERT GAS BREATHING

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DO - 10.1249/MSS.0000000000001308

M3 - Article

VL - 49

SP - 1758

EP - 1768

JO - Medicine and Science in Sports and Exercise

JF - Medicine and Science in Sports and Exercise

SN - 0195-9131

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ER -