PMID- 33992746 OWN - NLM STAT- MEDLINE DCOM- 20211208 LR - 20240214 IS - 1558-3597 (Electronic) IS - 0735-1097 (Print) IS - 0735-1097 (Linking) VI - 78 IP - 3 DP - 2021 Jul 20 TI - Associations of Cardiac Mechanics With Exercise Capacity: The Multi-Ethnic Study of Atherosclerosis. PG - 245-257 LID - S0735-1097(21)04971-8 [pii] LID - 10.1016/j.jacc.2021.04.082 [doi] AB - BACKGROUND: Lower 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 function with 6MWD are unclear, and may provide insight regarding the risk of incident HF. OBJECTIVES: The purpose of this study was to understand the relationships between cardiac function and exercise capacity. METHODS: This study evaluated the associations of cardiac mechanics with 6MWD in the sixth examination of the Multi-Ethnic Study of Atherosclerosis. Echocardiography (2-dimensional, Doppler, and speckle-tracking) was performed at rest and after passive leg raise to evaluate functional reserve after intravascular volume challenge. RESULTS: Of 2,096 participants without HF (mean age 73 years, 48% men, 58% non-White), individuals with lower (worse) left atrial (LA) reservoir strain were older and had higher blood pressure. Lower resting LA reservoir strain (beta coefficient per SD decrease: -5.0; 95% confidence interval [CI]: -8.8 to -1.3 m; p = 0.009), inability to augment LA reservoir strain after passive leg raise (beta coefficient per SD decrease: -5.8; 95% CI: -9.1 to -2.5 m; p < 0.001), and lower right atrial reservoir strain (beta coefficient per SD decrease: -4.4; 95% CI: -7.8 to -1.1 m; 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 measures of LV systolic function (global longitudinal strain, circumferential strain, ejection fraction) with 6MWD. CONCLUSIONS: Among 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. CI - Copyright (c) 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Patel, Ravi B AU - Patel RB AD - Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: https://twitter.com/RBPatelMD. FAU - Freed, Benjamin H AU - Freed BH AD - Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. FAU - Beussink-Nelson, Lauren AU - Beussink-Nelson L AD - Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. FAU - Allen, Norrina B AU - Allen NB AD - Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. FAU - Konety, Suma H AU - Konety SH AD - University of Minnesota, Minneapolis, Minnesota, USA. FAU - Post, Wendy S AU - Post WS AD - Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. FAU - Yeboah, Joseph AU - Yeboah J AD - Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. FAU - Kitzman, Dalane W AU - Kitzman DW AD - Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. FAU - Bertoni, Alain G AU - Bertoni AG AD - Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. FAU - Shah, Sanjiv J AU - Shah SJ AD - Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: sanjiv.shah@northwestern.edu. LA - eng GR - 75N92020D00005/HL/NHLBI NIH HHS/United States GR - N01HC95160/HL/NHLBI NIH HHS/United States GR - UL1 TR001079/TR/NCATS NIH HHS/United States GR - R01 HL127028/HL/NHLBI NIH HHS/United States GR - R01 AG018915/AG/NIA NIH HHS/United States GR - N01HC95164/HL/NHLBI NIH HHS/United States GR - N01HC95168/HL/NHLBI NIH HHS/United States GR - R01 HL107577/HL/NHLBI NIH HHS/United States GR - N01HC95159/HL/NHLBI NIH HHS/United States GR - 75N92020D00007/HL/NHLBI NIH HHS/United States GR - HHSN268201500003I/HL/NHLBI NIH HHS/United States GR - N01HC95167/HL/NHLBI NIH HHS/United States GR - UL1 TR000040/TR/NCATS NIH HHS/United States GR - R01 HL127659/HL/NHLBI NIH HHS/United States GR - 75N92020D00002/HL/NHLBI NIH HHS/United States GR - HHSN268201500003C/HL/NHLBI NIH HHS/United States GR - R01 HL140731/HL/NHLBI NIH HHS/United States GR - N01HC95163/HL/NHLBI NIH HHS/United States GR - 75N92020D00001/HL/NHLBI NIH HHS/United States GR - N01HC95169/HL/NHLBI NIH HHS/United States GR - N01HC95162/HL/NHLBI NIH HHS/United States GR - 75N92020D00003/HL/NHLBI NIH HHS/United States GR - KL2 TR001424/TR/NCATS NIH HHS/United States GR - N01HC95165/HL/NHLBI NIH HHS/United States GR - N01HC95161/HL/NHLBI NIH HHS/United States GR - UL1 TR001420/TR/NCATS NIH HHS/United States GR - 75N92020D00004/HL/NHLBI NIH HHS/United States GR - 75N92020D00006/HL/NHLBI NIH HHS/United States GR - N01HC95166/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural DEP - 20210513 PL - United States TA - J Am Coll Cardiol JT - Journal of the American College of Cardiology JID - 8301365 SB - IM CIN - J Am Coll Cardiol. 2021 Jul 20;78(3):258-259. PMID: 34266579 MH - Aged MH - Aged, 80 and over MH - Atherosclerosis/diagnosis/physiopathology/*therapy MH - Diastole MH - Echocardiography MH - *Ethnicity MH - Exercise Test MH - Exercise Tolerance/*physiology MH - Female MH - Follow-Up Studies MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Prospective Studies MH - United States/epidemiology MH - Ventricular Function, Left/*physiology PMC - PMC8299435 MID - NIHMS1717121 OTO - NOTNLM OT - 6-min walk test OT - cardiac structure and function OT - echocardiography OT - heart failure OT - subclinical COIS- Funding Support and Author Disclosures This research was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute; by grants KL2TR001424, UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences; and by grants R01 HL127028, R01 HL127659, and R01 AG18915 from the National Institutes of Health. Dr. Shah has received research grants from Actelion, AstraZeneca, Corvia, Novartis, and Pfizer; and has received consulting fees from Abbott, Actelion, AstraZeneca, Amgen, Axon Therapies, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardiora, CVRx, Cytokinetics, Eisai, GlaxoSmithKline, Ionis, Ironwood, Lilly, Merck, MyoKardia, Novartis, Novo Nordisk, Pfizer, Sanofi, Shifamed, Tenax, and United Therapeutics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. EDAT- 2021/05/17 06:00 MHDA- 2021/12/15 06:00 PMCR- 2022/07/20 CRDT- 2021/05/16 20:38 PHST- 2021/03/05 00:00 [received] PHST- 2021/04/15 00:00 [revised] PHST- 2021/04/30 00:00 [accepted] PHST- 2021/05/17 06:00 [pubmed] PHST- 2021/12/15 06:00 [medline] PHST- 2021/05/16 20:38 [entrez] PHST- 2022/07/20 00:00 [pmc-release] AID - S0735-1097(21)04971-8 [pii] AID - 10.1016/j.jacc.2021.04.082 [doi] PST - ppublish SO - J Am Coll Cardiol. 2021 Jul 20;78(3):245-257. doi: 10.1016/j.jacc.2021.04.082. Epub 2021 May 13.