| Left ventricular function and exercise capacity. | |
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MedLine Citation:
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PMID: 19155455 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: Limited information exists regarding the role of left ventricular function in predicting exercise capacity and impact on age- and sex-related differences. OBJECTIVES: To determine the impact of measures of cardiac function assessed by echocardiography on exercise capacity and to determine if these associations are modified by sex or advancing age. DESIGN: Cross-sectional study of patients undergoing exercise echocardiography with routine measurements of left ventricular systolic and diastolic function by 2-dimensional and Doppler techniques. Analyses were conducted to determine the strongest correlates of exercise capacity and the age and sex interactions of these variables with exercise capacity. SETTING: Large tertiary referral center in Rochester, Minnesota, in 2006. PARTICIPANTS: Patients undergoing exercise echocardiography using the Bruce protocol (N = 2867). Patients with echocardiographic evidence of exercise-induced ischemia, ejection fractions lower than 50%, or significant valvular heart disease were excluded. MAIN OUTCOME MEASURE: Exercise capacity in metabolic equivalents (METs). RESULTS: Diastolic dysfunction was strongly and inversely associated with exercise capacity. Compared with normal function, after multivariate adjustment, those with moderate/severe resting diastolic dysfunction (-1.30 METs; 95% confidence interval [CI], -1.52 to -0.99; P < .001) and mild resting diastolic dysfunction (-0.70 METs; 95% CI, -0.88 to -0.46; P < .001) had substantially lower exercise capacity. Variation of left ventricular systolic function within the normal range was not associated with exercise capacity. Left ventricular filling pressures measured by resting E/e' of 15 or greater (-0.41 METs; 95% CI, -0.70 to -0.11; P = .007) or postexercise E/e' of 15 or greater (-0.41 METs; 95% CI, -0.71 to -0.11; P = .007) were similarly associated with a reduction in exercise capacity, each in separate multivariate analyses. Individuals with impaired relaxation (mild dysfunction) or resting E/e' of 15 or greater had a progressive increase in the magnitude of reduction in exercise capacity with advancing age (P < .001 and P = .02, respectively). Other independent correlates of exercise capacity were age (unstandardized beta coefficient, -0.85 METs; 95% CI, -0.92 to -0.77, per 10-year increment; P < .001), female sex (-1.98 METs; 95% CI, -2.15 to -1.84; P < .001), and body mass index greater than 30 (-1.24 METs; 95% CI, -1.41 to -1.10; P < .001). CONCLUSION: In this large cross-sectional study of those referred for exercise echocardiography and not limited by ischemia, abnormalities of left ventricular diastolic function were independently associated with exercise capacity. |
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Authors:
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Jasmine Grewal; Robert B McCully; Garvan C Kane; Carolyn Lam; Patricia A Pellikka |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 301 ISSN: 1538-3598 ISO Abbreviation: JAMA Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2009-01-21 Completed Date: 2009-01-23 Revised Date: 2011-05-13 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: United States |
Other Details:
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Languages: eng Pagination: 286-94 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Blood Pressure Cross-Sectional Studies Diastole Echocardiography, Doppler Echocardiography, Stress* Exercise Test Exercise Tolerance* Female Heart Rate Humans Male Middle Aged Ventricular Function, Left* |
| Grant Support | |
ID/Acronym/Agency:
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1 UL1 RR024150/RR/NCRR NIH HHS; UL1 RR024150-02/RR/NCRR NIH HHS; UL1 RR024150-04/RR/NCRR NIH HHS |
| Comments/Corrections | |
Comment In:
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JAMA. 2009 Jun 10;301(22):2326; author reply 2326-7
[PMID:
19509377
]
JAMA. 2009 Jun 10;301(22):2325-6; author reply 2326-7 [PMID: 19509376 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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