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Background: Estimation of left ventricular filling pressure (LVFP) is the essential part of the echocardiographic workup for exercise intolerance. The ratio of the mitral early filling velocity to the left ventricular global longitudinal strain (E/LVGLS) has emerged as a novel index of LVFP. This study aimed to investigate the relationship between E/LVGLS and exercise capacity. Methods and results: We retrospectively reviewed 90 patients with exertional dyspnea who underwent echocardiography and cardiopulmonary exercise test. Patients were classified into three groups according to their percent‐predicted maximal oxygen consumption (ppVo2) (G ≧ 75, ppVo2 > 75%, n = 20; G 50‐75, ppVo2 75‐50%, n = 57; G < 50, ppVo2 < 50%, n = 13). Measurements were (a) the relationship between ppVo2 and E/LVGLS and (b) the efficiency of integrated diastolic assessment using E/LVGLS, left ventricular volume, mitral annular early diastolic velocity (E′), and tricuspid regurgitation to identify the patient with impaired exercise capacity. Univariate linear regression analysis demonstrated that E/LVGLS had significant correlation with ppVo2 (ρ = 0.52, P < 0.001). The area under the ROC of E/LVGLS for ppVo2 < 50% was 0.86 (95%CI 0.75‐0.97). The DeLong test showed that E/LVGLS was efficient to detect ppVo2 < 50% than E/E′ (P = 0.007). When used in the integrated assessment of LVFP as the alternative for E/E′, E/LVGLS improved risk classification for impaired exercise capacity. Conclusion: E/LVGLS may be a more efficient index than E/E′ to identify exercise impairment as a single index and as a part of the integrated diastolic assessment. [ABSTRACT FROM AUTHOR]

Background Nearly half of patients with heart failure have normal left ventricular ejection fraction ( LVEF), but their prognosis is no better than those with reduced LVEF. Although peak oxygen consumption ( VO2) is an independent predictor of mortality in heart failure, it is unclear how cardiac function during exercise contributes to peak VO2. Therefore, we explored the useful parameters measured by exercise stress echocardiography to predict peak VO2 in patients with heart failure with preserved LVEF ( HFp EF). Methods and Results We assessed 80 patients being investigated for effort intolerance or dyspnea and finally analyzed 50 patients who satisfied the HFp EF criteria. Mean peak VO2 was 16.4±2.8 mL/kg/min. Twenty-three patients (46.0%) achieved a peak VO2 <16.0 mL/kg/min (Weber class C or D). There was a significant relationship between mitral systolic velocity (S′) and cardiac output ( CO) at rest ( R=.55, P<.0001) and peak exercise ( R=.64, P<.0001). The absolute increase in S′ from rest to peak exercise also correlated with the absolute increase in CO ( R=.32, P=.02). Multivariate logistic regression analysis showed that S′ at peak exercise independently predicted peak VO2. Receiver-operator characteristic curve analysis identified that an S′ at peak exercise of ≤8.13 cm/s predicted a peak VO2 <16.0 mL/kg/min (sensitivity 95.7%, specificity 44.4%, area under curve 0.70, 95% confidence interval 0.55-0.84, P=.004). Conclusions Mitral systolic velocity at peak exercise accurately reflects peak VO2 and may facilitate stratification of risk in patients with HFp EF. [ABSTRACT FROM AUTHOR]