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Journal Club 13 May 2015

Paper

Abnormal Left Ventricular Contractile Response to
Exercise in the Absence of Obstructive Coronary Artery Disease Is Associated with Resting Left Ventricular Long-Axis Dysfunction

Presenter

SP

Summary

Background

The etiology of reduced left ventricular (LV) ejection fraction after exercise, without obstructive
coronary artery disease or other established causes, is unclear. The aims of this study were to determine
whether patients undergoing treadmill stress echocardiography with this abnormal LV contractile response
to exercise (LVCRE) without established causes have resting LV long-axis dysfunction or microvascular
dysfunction and to determine associations with this abnormal LVCRE.

Methods

Of 5,275 consecutive patients undergoing treadmill stress echocardiography, 1,134 underwent cardiac
computed tomography angiography or invasive angiography. Having excluded patientswith obstructive coronary
artery disease, hypertensive response, submaximal heart rate response, resting LV ejection fraction < 50%, and
valvular disease, 110 with ‘‘abnormal LVCRE’’ and 212 with ‘‘normal LVCRE’’ were analyzed. Resting mitral
annular velocities were measured to assess LV long-axis function. Myocardial blush grade and corrected Thrombolysis
InMyocardial Infarction frame count were determined angiographically to assess microvascular function.

Results

Comparing normal LVCRE with abnormal LVCRE, age (mean, 59.7 6 11.1 vs 61.4 6 10.0 years),
hypertension (53% vs 55%), diabetes (16% vs 20%), and body mass index (mean, 29.1 6 5.4 vs
29.5 6 6.4 kg/m2) were similar (P > .05). Abnormal LVCRE had reduced resting LV long-axis function with lower
septal (mean, 6.1 6 1.9 vs 7.7 6 2.2 cm/sec) and lateral (mean, 8.1 6 2.9 vs 10.4 6 3.0 cm/sec) e0 velocities
(P < .001) and larger resting left atrial volumes (mean, 37.3 6 10.1 vs 31.1 6 7.2 mL/m2, P < .001). On
multivariate analysis, femalegender (oddsratio[OR],1.21;95%confidence interval [CI],1.15–1.99;P<.001), exaggerated
chronotropic response (OR,1.49;95%CI, 1.09–2.05;P<.001), resting left atrial volume(OR, 2.38;95%CI,
1.63–3.47; P < .001), and resting lateral e0 velocity (OR, 1.70; 95%CI, 1.22–2.49; P = .003) were associated with
abnormal LVCRE, but notmyocardial blush grade or corrected Thrombolysis InMyocardial Infarction frame count.

Conclusions

An abnormal LVCRE in the absence of established causes is associated with resting LV long-axis
dysfunction and is usually seen in women.

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