Eccentric Left Ventricular Hypertrophy and Left and Right Cardiac Function in Chronic Heart Failure with or without Coexisting COPD: Impact on Exercise Performance

Figures & data

Figure 1 Study flow chart (screened patients n=222).

Table 1 Anthropometric and Clinical Characteristics of Studied Subjects

Variables	CHF (n= 23)	CHF+COPD (n= 23)	p
Age, years	60 ± 9	68 ± 6	0.002
Gender, M/F (n)	18/5	23/0	0.03
Height, cm	169 ± 7	168 ± 7	0.46
Weight, kg	79 ± 15	74 ± 15	0.12
BMI, kg/m^Citation2	27 ± 5	27 ± 7	0.92
Cardiac function
Indexed LA volume, mL/m^Citation2	39 ± 22	33 ± 15	0.37
Indexed RA volume, mL/m^Citation2	35 ± 19	30 ± 19	0.57
Left ventricle measures
Ejection Fraction, %	40 ± 5	38 ± 7	0.27
Dysfunction classification of LV, Mild/Moderate/Severe	13/9/1	8/12/3	0.27
Indexed LV mass, gm/m^Citation2	138 (120–153)	143 (124–179)	0.40
Relative LV wall thickness	0.35 (0.28–0.39)	0.35 (0.31–0.37)	0.74
LVEDD, mm	62 ± 9	62 ± 6	0.91
LVESD, mm	45 ± 16	52 ± 8	0.16
Mitral E wave, cm/sec	65 ± 28	68 ± 23	0.78
Mitral A wave, cm/sec	61 ± 23	76 ± 24	0.14
Mitral e’ wave, cm/sec	8.9 ± 2	7.1 ± 2	0.04
Mitral a’ wave, cm/sec	9.5 ± 2	9.5 ± 3	0.97
Mitral S wave, cm/sec	7.4 ± 1	7.7 ± 2	0.71
E/A ratio. cm/sec	1.0 ± 0.3	0.9 ± 0.6	0.76
E/e’ ratio. cm/sec	8.6 ± 3	10.3 ± 4	0.30
Right ventricle measures
RVD, mm	37 ± 4	30 ± 7	0.005
Tricuspid E wave, cm/sec	47 ± 11	41 ± 11	0.24
Tricuspid A wave, cm/sec	41 ± 13	47 ± 6	0.31
Tricuspid e’ wave, cm/sec	11 ± 3	11 ± 2	0.99
Tricuspid a’ wave, cm/sec	12 ± 5	13 ± 2	0.54
Tricuspid S wave, cm/sec	11 ± 2	11 ± 2	0.71
E/A ratio. cm/sec	1.3 ± 0.6	0.8 ± 0.2	0.03
E/e’ ratio. cm/sec	4.6 ± 1.0	3.4 ± 0.8	0.04
Pulmonary function
FEV1, L/s	2.7 ± 0.7	2.0 ± 0.5	<0.001
FEV1, %	79 ± 21	65 ± 17	0.01
FVC, L/s	3.5 ± 0.9	3.3 ± 0.7	0.50
FVC, %	85 ± 12	84 ± 19	0.71
FEV1/FVC, L/s	0.78 ± 0.04	0.58± 0.11	<0.001
GOLD Stage, I/II/III/IV	–	8/11/4/0	–
MVV, L	103 ± 27	76 ± 21	0.001
RV, L/s	2.4 ± 0.7	3.0 ± 0.9	0.04
RV, %pred	109± 38	136 ± 44	0.08
TLC, L/s	4.5 ± 1.4	5.8 ± 1.1	0.004
TLC, %pred	74 ± 21	93 ± 23	0.01
RV/TLC, %	0.51 ± 0.13	0.51 ± 0.10	0.83
IC, L/s	1.8 ± 0.6	2.2 ± 1.1	0.14
IC, %pred	63 ± 28	63 ± 26	0.98
DLCO	20 ± 4	14 ± 5	0.002
DLCO, %	78 ± 12	52 ± 12	<0.001
Functional classification
NYHA functional class, I/II/II/IV	9/10/4/0	9/9/5/0	0.72
mMRC dyspnoea score, 0/I/II/III/IV	–	2/8/7/2/4	–
Medications
LABA, n (%)	0 (0)	8(34)	–
SABA, n (%)	0 (0)	3(13)	–
LAMA, n (%)	0 (0)	10(43)	–
Beta-blockers, n (%)	22 (96)	22 (96)	0.31
ACE inhibitors, n (%)	9 (39)	16 (69)	0.07
Diuretics, n (%)	22 (96)	11 (47)	<0.001
Comorbidities
Hypertension, n (%)	18 (78)	20 (86)	0.13
DM, n (%)	9 (39)	10 (43)	0.86
CI, n (%)	3 (13)	4 (17)	0.72
Dyslipidemia, n (%)	10 (43)	14 (60)	0.30
Others, n (%)	17 (73)	13 (56)	0.14

Note: Used Unpaired Student’s t test for continuous variables and used chi-square test for categorical variables.

Abbreviations: CHF, chronic heart failure; COPD, chronic obstructive pulmonary disease; M, male; F, female; BMI, body mass index; LA, left atrium; RA, right atrium; LV, left ventricle; LVEDD, left ventricular end-diastolic diameter; LVESD, left ventricular end-systolic diameter; RVD, right ventricle diameter; FEV1, forced expiratory volume in 1s; FVC, forced vital capacity; MVV, maximal voluntary ventilation; RV, residual volume; TLC, total lung capacity; IC, inspiratory capacity; DLCO, diffusion capacity carbon monoxide; NYHA, New York Heart Association; mMRC, modified Medical Research Council scale; LABA, long-acting β2 adrenoceptor agonist; SABA, short-acting beta-agonists; LAMA, long-acting muscarinic antagonists; ACE, angiotensin converting enzyme; DM, diabetes mellitus; CI, coronary insufficiency.

Table 2 Comparison Between Group Responses to Incremental CPET

Variables	CHF (n=23)	CHF+COPD (n=23)	p
Work rate, Watts	86 ± 30	57 ± 18	<0.001
Work rate predicted, Watts	130±29	109±23	0.01
Work rate % of predicted, %	66±20	54±18	0.05
Metabolic responses
VO2 predicted, mL.min	1907 ± 423	1603 ± 299	0.008
VO2 peak, mL.min	1109 ± 349	847 ± 307	0.01
VO2% of predicted, %	57 ± 12	53 ±18	0.43
VO2 peak, mL.kg^−1.min−^Citation1	13.3 (11.0–15.4)	13.7 (10.9–14.7)	0.32
VO2/WR, mL.min.W	13 ± 3	15 ± 4	0.16
VCO2, mL.min	1232 ± 439	792 ± 348	0.003
RER peak	1.09 ± 0.11	1.05 ± 0.09	0.19
Cardiovascular responses
HR rest, bpm	73 ± 10	91 ± 6	<0.001
HR maximal, bpm	159 ± 9	152 ± 6	0.002
HR peak, bpm	121 ± 18	112 ± 25	0.17
HR % of maximal	76 ± 11	74 ± 17	0.63
HR rec, bpm	107±21	106 ±22	0.90
∆ HRrec, bpm	26± 20	23 ± 17	0.68
SBPrest, mmHg	122 ± 13	116 ± 20	0.24
DBPrest, mmHg	81 ± 8	76 ± 11	0.11
SBPpeak, mmHg	200 ± 31	168 ± 46	0.008
DBPpeak, mmHg	112 ± 15	97 ± 25	0.01
Peak O2 pulse, mL/beat	10 ± 3	5 ± 2	<0.001
RPP, bpm.mmHg	24,516± 5887	19,391 ± 8157	0.01
CP, mmHg.mL.kg^−1 min^−1	2730 ± 768	2051 ± 735	0.004
Ventilatory responses
VE, L.min	50 ± 17	39 ± 16	0.03
VE/MVV, L.min	0.49 ± 0.16	0.53 ± 17	0.45
VE/VCO2 slope	37 ± 6	38 ± 15	0.68
VE/VCO2 intercept, L/minute	1.2 ± 1	2.2 ± 3	0.35
OUES	1.39 ± 0.3	1.21 ± 0.5	0.20
VP, mmHg	5.6 (4.9–6.1)	3.7 (3.1–5.8)	0.005
Gas exchange responses
SaO2rest, %	95 ± 1	95 ± 2	0.23
SaO2peak, %	94 ± 3	94 ± 2	0.63
Perception of symptoms
Peak dyspnea score, 0–10	4 ± 3	7 ± 2	0.01
Peak leg effort score, 0–10	3 ± 2	6 ± 3	0.01

Note: Used unpaired Student’s t test.

Abbreviations: CHF, chronic heart failure; COPD, chronic obstructive pulmonary disease; VO₂, oxygen uptake; VCO₂, carbon dioxide output; RER, respiratory exchange ratio; HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure; RPP, rate-pressure product; CP, circulatory power; VE, ventilation; MVV, maximal voluntary ventilation; V_E/VCO₂ slope, linear relation between minute ventilation and carbon dioxide output; OUES, linear relationship between oxygen uptake and minute ventilation; VP, ventilatory power; SaO₂, peripheral saturation of O₂.

Figure 2 Correlation between cardiac function and CPET responses in CHF group; Used Pearson correlation coefficient. LV, left ventricle; In (A) relationship between log-ventilatory power and log-relative wall thickness (r: 0.45 p: 0.03); (B) relationship between V_E/VCO₂ intercept and Mitral E/e’ ratio (r: 0.70 p: 0.003).

Figure 3 Correlation between cardiac function and CPET responses in CHF+COPD group; Used Pearson correlation coefficient. LV, left ventricle; In (A) log-relative VO₂ and right ventricle diameter (r: −0.47; p: 0.02); (B) log-indexed LV mass and rate pressure product (r: −0.62; p: 0.001).

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