Associations of Cardiac Mechanics with Exercise Capacity: The Multi-Ethnic Study of Atherosclerosis.

Abstract

BACKGROUND\nLower exercise capacity, as measured by 6-minute walk distance (6MWD), is associated with incident heart failure (HF). Among those without HF, the associations of measures of cardiac structure and function with 6MWD are unclear, and may provide insight regarding the risk of incident HF.\n\n\nOBJECTIVES\nTo understand the relationships between cardiac function and exercise capacity.\n\n\nMETHODS\nWe evaluated the associations of cardiac mechanics with 6MWD in the 6th exam of the Multi-Ethnic Study of Atherosclerosis. Two-dimensional, Doppler and speckle-tracking echocardiography was performed at rest and after passive leg raise to evaluate functional reserve after intravascular volume challenge.\n\n\nRESULTS\nOf 2,096 participants without HF (mean age: 73, 48% male, 58% non-White), individuals with lower (worse) left atrial (LA) reservoir strain were older and had higher blood pressure. Lower resting LA reservoir strain (β coefficient per SD decrease: -5.0, 95% CI: -8.8, -1.3 meters; P=0.009), inability to augment LA reservoir strain after passive leg raise (β coefficient per SD decrease: -5.8, 95% CI: -9.1, -2.5 meters; P<0.001), and lower right atrial reservoir strain (β coefficient per SD decrease: -4.4, 95% CI: -7.8, -1.1 meters; P=0.01) were associated with shorter 6MWD. Worse left ventricular (LV) diastolic function was also associated with lower 6MWD. There were no independent associations of indices of LV systolic function (global longitudinal strain, circumferential strain, ejection fraction) with 6MWD.\n\n\nCONCLUSION\nAmong individuals without HF, worse biatrial function, lack of LA functional reserve, and worse LV diastolic function were associated with reduced submaximal exercise capacity. Therapies aimed to improve these functional domains may increase exercise capacity and prevent HF.